CPT Code 21070

CPT code 21070 is for the surgical removal of the coronoid process, a part of the jawbone.

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What is CPT Code 21070

CPT code 21070 is used for the surgical procedure to remove the coronoid process, which is a part of the lower jawbone (mandible). This code is typically used when a surgeon needs to excise this bony prominence to address issues such as restricted jaw movement or other related conditions.

Does CPT 21070 Need a Modifier?

When billing for the CPT code 21070 (Remove coronoid process), 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 21070, 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 increased complexity, time, or patient condition.

2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body during the same session.

3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.

4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.

5. 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. This is particularly important if the procedures are not typically reported together.

6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same procedure was repeated by the same physician on the same day.

7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the procedure was repeated by a different physician on the same day.

8. Modifier 78 - Unplanned Return to the Operating Room
- This modifier is used if the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.

9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required to help perform the procedure.

11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.

12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.

13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.

By appropriately applying these modifiers, healthcare providers can ensure accurate coding, billing, and reimbursement for the procedure associated with CPT code 21070.

CPT Code 21070 Medicare Reimbursement

Medicare reimbursement for CPT code 21070, which pertains to the removal of the coronoid process, depends on several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the clinical necessity of the procedure, and whether the procedure is performed in an inpatient or outpatient setting.

As of the latest available data, Medicare does reimburse for CPT code 21070 when the procedure is deemed medically necessary. The reimbursement amount can vary based on geographic location and the setting in which the procedure is performed. For instance, the Medicare Physician Fee Schedule (MPFS) may list different rates for hospital outpatient departments compared to ambulatory surgical centers.

To obtain the most accurate and up-to-date reimbursement amount for CPT code 21070, healthcare providers should consult the MPFS Look-Up Tool available on the Centers for Medicare & Medicaid Services (CMS) website or contact their local MAC. This will provide the specific allowable amount based on the provider's location and other relevant factors.

In summary, CPT code 21070 is reimbursed by Medicare, but the exact reimbursement amount should be verified through official CMS resources or the local MAC.

Are You Being Underpaid for 21070 CPT Code?

Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 21070 for the removal of the coronoid process. 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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