CPT code 21932 is for the surgical excision of a deep tumor in the back that is less than 5 cm in size.
CPT code 21932 is used for the surgical procedure involving the excision (removal) of a deep tumor located in the back, where the tumor is less than 5 centimeters in size.
For CPT code 21932, which refers to the excision of a back tumor that is deep and less than 5 cm, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. For example, if the tumor is in a particularly challenging location or if there are complications that make the procedure more complex.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both sides of the body, this modifier should be used to indicate that the excision was bilateral.
3. Modifier 51 (Multiple Procedures): When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was carried out.
4. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. For instance, if another unrelated procedure was performed in conjunction with the excision.
5. Modifier 76 (Repeat Procedure by Same Physician): If the same physician needs to repeat the procedure on the same day, this modifier should be used.
6. Modifier 77 (Repeat Procedure by Another Physician): If a different physician repeats the procedure on the same day, this modifier is applicable.
7. 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 needs to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If an unrelated procedure is performed by the same physician during the postoperative period, this modifier should be used.
9. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required for the procedure, this modifier should be appended.
10. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): If an assistant surgeon is necessary because a qualified resident surgeon is not available, this modifier should be used.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare reimbursement for CPT code 21932, which refers to the excision of a back tumor that is deep and less than 5 cm, is subject to several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed (e.g., hospital outpatient, ambulatory surgical center, or physician's office), and whether the procedure is deemed medically necessary.
As of the latest available data, Medicare does reimburse for CPT code 21932, provided that the procedure meets the medical necessity criteria and is properly documented. The reimbursement amount can vary based on geographic location and the specific Medicare fee schedule applicable to the provider's practice setting.
For instance, in a physician's office setting, the national average reimbursement rate for CPT code 21932 might be approximately $500-$700. However, this amount can fluctuate based on local adjustments and other factors.
To obtain the most accurate and up-to-date reimbursement information, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) or contact their local MAC. Additionally, verifying the specific coverage policies and any potential prior authorization requirements is crucial to ensure proper reimbursement.
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 21932 for excision of back tumors less than 5 cm deep. Schedule a demo today to see how RevFind can ensure you receive every dollar you're owed from each payer.
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