CPT code 21740 is for the reconstruction of the sternum, a surgical procedure to repair or rebuild the breastbone.
CPT code 21740 is for the surgical procedure involving the reconstruction of the sternum. This code is used when a healthcare provider performs surgery to repair or rebuild the breastbone, which may be necessary due to trauma, congenital defects, or other medical conditions affecting the sternum.
When billing for CPT code 21740 (Reconstruction of sternum), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 21740, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as the patient's condition or the complexity of the surgery.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed, and it helps in the correct allocation of reimbursement.
3. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This could occur if the full reconstruction was not necessary or feasible.
4. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is particularly useful if another procedure was performed that is not typically reported together with 21740.
6. Modifier 62 - Two Surgeons
- Apply this modifier if two surgeons were required to perform the procedure together, each acting as a primary surgeon for distinct parts of the surgery.
7. Modifier 66 - Surgical Team
- Use this modifier if the procedure required a surgical team due to its complexity. This indicates that multiple surgeons with different specialties were involved.
8. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician performed the procedure more than once on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performed the procedure more than once on the same day.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial surgery.
12. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and compliance with payer guidelines. Always verify with the specific payer for any additional requirements or restrictions related to the use of modifiers.
Medicare reimbursement for CPT code 21740, which pertains to the reconstruction of the sternum, is subject to several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed (e.g., inpatient hospital, outpatient hospital, or ambulatory surgical center), and the patient's individual Medicare plan.
As of the latest available data, Medicare does reimburse for CPT code 21740 under certain conditions. The reimbursement amount can vary based on geographic location and the specific details of the procedure. For instance, the Medicare Physician Fee Schedule (MPFS) provides a national average reimbursement rate, but this rate is adjusted by local cost indices.
To obtain the most accurate and up-to-date reimbursement amount for CPT code 21740, healthcare providers should consult the MPFS Look-Up Tool on the Centers for Medicare & Medicaid Services (CMS) website or contact their local MAC. Additionally, providers can reference the CMS Addendum B for outpatient prospective payment system (OPPS) rates if the procedure is performed in an outpatient setting.
In summary, while Medicare does reimburse for CPT code 21740, the exact amount can vary, and providers should verify the specific reimbursement rate applicable to their practice location and setting.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 21740 for the reconstruction of the sternum. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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