CPT Code 20910

CPT code 20910 is a medical billing code used to describe the procedure of removing cartilage for grafting purposes.

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What is CPT Code 20910

CPT code 20910 is used for the procedure where cartilage is removed from one part of the body to be used as a graft in another area. This code specifically refers to the surgical removal of cartilage tissue, which can then be transplanted to repair or reconstruct damaged cartilage in a different location.

Does CPT 20910 Need a Modifier?

When using CPT code 20910 for the removal of cartilage for graft, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:

1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.

2. Modifier 50 (Bilateral Procedure): Applied 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 59 (Distinct Procedural Service): Indicates that the procedure is distinct or independent from other services performed on the same day. This could be due to different anatomical sites or separate patient encounters.

5. Modifier 76 (Repeat Procedure by Same Physician): Used if the same procedure is repeated by the same physician on the same day.

6. Modifier 77 (Repeat Procedure by Another Physician): Applied when the same procedure is repeated by a different physician on the same day.

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): 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): Indicates that the procedure is unrelated to the original procedure and is performed during the postoperative period.

9. Modifier LT (Left Side): Used to specify that the procedure was performed on the left side of the body.

10. Modifier RT (Right Side): Used to specify that the procedure was performed on the right side of the body.

11. Modifier 99 (Multiple Modifiers): Applied when two or more modifiers are necessary to describe the service accurately.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always consult the latest CPT coding guidelines and payer-specific requirements to determine the appropriate use of modifiers.

CPT Code 20910 Medicare Reimbursement

When considering whether Medicare reimburses for a specific CPT code, such as 20910 (Remove cartilage for graft), it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs) provided by Medicare Administrative Contractors (MACs).

For CPT code 20910, Medicare does provide reimbursement, but the amount can vary based on geographic location and specific circumstances of the procedure. As of the latest update, the national average reimbursement rate for CPT code 20910 is approximately $300. However, this amount can fluctuate due to factors such as the facility setting (e.g., hospital outpatient department vs. physician's office) and any applicable modifiers.

To obtain the most accurate and up-to-date reimbursement information, healthcare providers should refer to the MPFS on the Centers for Medicare & Medicaid Services (CMS) website or consult their local MAC. Additionally, it is advisable to verify any specific coverage policies or documentation requirements that may impact reimbursement for this procedure.

Are You Being Underpaid for 20910 CPT Code?

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 20910 for cartilage removal for grafts. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and protect your revenue.

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