CPT code 21705 is for the revision of a neck muscle or rib procedure.
CPT code 21705 is for the surgical procedure involving the revision of a neck muscle or rib. This typically means that a previous surgery in the neck or rib area needs to be corrected or modified, often to improve function or alleviate complications.
For CPT code 21705 (Revision of neck muscle/rib), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
7. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period of the initial procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
Medicare reimbursement for CPT code 21705, which pertains to the revision of neck muscle or rib, depends on several factors including the medical necessity of the procedure, the setting in which it is performed, and the specific Medicare Administrative Contractor (MAC) guidelines in your region.
As of the latest available data, Medicare does reimburse for CPT code 21705, provided that the procedure is deemed medically necessary and is supported by appropriate documentation. The reimbursement amount can vary based on geographic location and other factors, but as a general reference, the national average payment for this procedure under the Medicare Physician Fee Schedule (MPFS) is approximately $1,200. However, this amount can fluctuate, so it is advisable to check the most current MPFS or consult directly with your MAC for precise figures.
For the most accurate and up-to-date information, healthcare providers should verify the specific reimbursement rates and coverage criteria through their local MAC or the Centers for Medicare & Medicaid Services (CMS) website.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments down to the CPT code level and by individual payer. For example, if you're performing CPT code 21705 for the revision of neck muscle/rib, RevFind ensures you're reimbursed accurately. Schedule a demo today to see how RevFind can optimize your revenue cycle and protect your bottom line.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
