CPT code 21750 is for the surgical repair of a separated sternum, ensuring proper alignment and healing of the chest bone.
CPT code 21750 is for the surgical procedure to repair a separation of the sternum, which is the bone located in the center of the chest. This code is used by healthcare providers to document and bill for the specific service of fixing a sternum that has become separated, ensuring accurate reimbursement from insurance companies.
For CPT code 21750 (Repair of sternum separation), 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 50 - Bilateral Procedure: If the repair of sternum separation was performed bilaterally, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier should be used to indicate that.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: If the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier should be used.
6. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons: If two surgeons were required to perform the procedure, this modifier should be appended.
8. Modifier 76 - Repeat Procedure by Same Physician: If the same physician performed the procedure more than once on the same day, this modifier should be used.
9. Modifier 77 - Repeat Procedure by Another Physician: If a different physician performed the procedure more than once on the same day, this modifier should be used.
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: Use 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: If the procedure was unrelated to the original procedure and performed during the postoperative period, this modifier should be used.
12. Modifier 80 - Assistant Surgeon: If an assistant surgeon was necessary for the procedure, this modifier should be appended.
13. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): If an assistant surgeon was necessary due to the unavailability of a qualified resident surgeon, this modifier should be used.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Use this modifier if a PA, NP, or CNS assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used to provide additional information about the circumstances under which the procedure was performed. Proper use of modifiers ensures accurate billing and reimbursement.
Medicare reimbursement for CPT code 21750, which pertains to the repair of sternum separation, depends on several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed, and the patient's individual coverage plan. Generally, Medicare Part B may cover this procedure if it is deemed medically necessary and performed in an outpatient setting, while Medicare Part A may cover it if performed in an inpatient setting.
To determine the exact reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or the specific MAC's fee schedule. As of the latest update, the national average reimbursement rate for CPT code 21750 under the MPFS is approximately $1,200. However, this amount can vary based on geographic location and other factors.
For the most accurate and up-to-date information, providers should consult the CMS website or their local MAC.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 21750 for the repair of sternum separation. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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
