CPT Code 21159

CPT code 21159 is a medical code used to describe a Lefort III fracture repair with forehead advancement, without a Lefort I osteotomy.

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What is CPT Code 21159

CPT code 21159 is for a surgical procedure known as a LeFort III osteotomy with forehead advancement, without performing a LeFort I osteotomy. This complex surgery involves repositioning the midface and forehead to correct congenital or traumatic deformities.

Does CPT 21159 Need a Modifier?

For CPT code 21159 (Lefort III with forehead advancement without Lefort I), the following modifiers may be applicable depending on the specific circumstances of the procedure and the patient's condition:

1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.

2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.

3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.

4. Modifier 52 - Reduced Services: Used when the service or procedure is partially reduced or eliminated at the physician's discretion.

5. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.

6. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.

7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.

8. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure.

9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician repeats a procedure or service.

10. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician.

11. 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 when the patient requires a return to the operating room for a related procedure during the postoperative period.

12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.

13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.

14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.

15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.

16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in surgery.

Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT and payer guidelines for the most current and applicable modifiers.

CPT Code 21159 Medicare Reimbursement

Medicare reimbursement for CPT code 21159, which pertains to a Lefort III fracture repair with forehead advancement without Lefort I, is contingent upon several factors including medical necessity, the setting in which the procedure is performed, and the specific Medicare Administrative Contractor (MAC) policies in the region where the service is provided.

Generally, Medicare does cover medically necessary surgical procedures, including complex craniofacial surgeries like the Lefort III fracture repair. However, the exact reimbursement amount can vary. As of the latest available data, the national average reimbursement for CPT code 21159 under the Medicare Physician Fee Schedule (MPFS) is approximately $2,500 to $3,000. This amount can fluctuate based on geographic adjustments and other factors.

For the most accurate and up-to-date information, healthcare providers should consult the Medicare Fee Schedule Lookup Tool or contact their local MAC. Additionally, verifying coverage criteria and obtaining prior authorization when necessary can help ensure proper reimbursement.

Are You Being Underpaid for 21159 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 21159 for Lefort III with forehead advancement without Lefort I. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.

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