CPT Code 21122

CPT code 21122 is for the reconstruction of the chin, detailing the specific medical procedure for accurate billing and insurance purposes.

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What is CPT Code 21122

CPT code 21122 is for the surgical procedure involving the reconstruction of the chin. This typically includes reshaping or rebuilding the chin structure to correct deformities, improve function, or enhance appearance.

Does CPT 21122 Need a Modifier?

For CPT code 21122 (Reconstruction of chin), the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.

2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that multiple procedures were performed and helps in appropriate reimbursement.

3. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used. Documentation should explain why the service was reduced.

4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.

5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to the complexity, this modifier should be used. Both surgeons must document their individual contributions to the procedure.

6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day. It indicates that the procedure was necessary to be repeated.

7. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier when the same procedure is repeated by a different physician on the same day. It indicates that the procedure was necessary to be repeated by another provider.

8. 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 when a patient requires a 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: Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to assist with the procedure. Documentation should support the necessity of the assistant surgeon.

11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when a minimum assistant surgeon is required. This indicates that the assistant surgeon's involvement was minimal but necessary.

12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required 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 non-physician provider assists in the surgery.

Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.

CPT Code 21122 Medicare Reimbursement

Medicare reimbursement for CPT code 21122, which pertains to the reconstruction of the chin, depends on several factors including medical necessity, documentation, and the specific Medicare Administrative Contractor (MAC) policies in your region. Generally, Medicare does cover reconstructive surgeries if they are deemed medically necessary, such as in cases of trauma, congenital defects, or other medical conditions that impair normal function.

However, if the procedure is considered cosmetic, Medicare typically does not provide reimbursement. To determine the exact reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or consult their local MAC. As of the latest available data, the national average reimbursement for CPT code 21122 is approximately $1,200, but this amount can vary based on geographic location and other factors.

For the most accurate and up-to-date information, it is advisable to check the MPFS or contact your local MAC directly.

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