CPT code 21743 is for the repair of the sternum using the Nuss procedure with a scope.
CPT code 21743 is for the surgical procedure involving the repair of the sternum using a Nuss procedure with the assistance of a scope. This minimally invasive technique is typically used to correct conditions like pectus excavatum, where the sternum is sunken in. The use of a scope allows for better visualization and precision during the surgery.
For CPT code 21743 (Repair sternum/nuss w/scope), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same surgical session.
3. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day.
5. Modifier 62 - Two Surgeons: Apply this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure.
6. Modifier 66 - Surgical Team: Use this modifier if the procedure required a surgical team due to its complexity.
7. Modifier 76 - Repeat Procedure by Same Physician: Apply this modifier if the same physician performed the procedure again on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if a different physician performed the procedure again on the same day.
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: This modifier is used if the patient required an unplanned return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier if the procedure was unrelated to the original procedure and was performed during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier if a minimum assistant surgeon was required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Apply this modifier if a non-physician practitioner assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines set forth by the American Medical Association (AMA) and payer policies to ensure accurate billing and reimbursement.
Medicare reimbursement for CPT code 21743, which pertains to the repair of the sternum using the Nuss procedure with a scope, depends on several factors including the specific Medicare plan, the setting in which the procedure is performed, and the geographical location. Generally, Medicare Part B may cover this procedure if it is deemed medically necessary and performed in an outpatient setting. However, the reimbursement amount can vary.
As of the latest available data, the national average reimbursement rate for CPT code 21743 under Medicare is approximately $1,500 to $2,000. It's important to verify the exact amount with the Medicare Administrative Contractor (MAC) for your region, as rates can differ based on local adjustments and specific circumstances.
For the most accurate and up-to-date information, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) or contact their local MAC.
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