CPT Code 21387

CPT code 21387 is for the open treatment of an orbit fracture, involving a combined approach.

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What is CPT Code 21387

CPT code 21387 is for the open treatment of an orbital fracture, which involves surgical intervention to repair a broken bone around the eye socket. This procedure typically requires making an incision to access and fix the fractured bones, often using plates, screws, or other hardware to stabilize the area and ensure proper healing.

Does CPT 21387 Need a Modifier?

For CPT code 21387 (Open treatment of orbital fracture, combined approach with internal fixation), the following modifiers may be applicable:

1. Modifier 22 (Increased Procedural Services): Used when the work required to provide a service is substantially greater than typically required. This could be due to complications or additional time and effort needed during the procedure.

2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.

3. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Used if a subsequent procedure is planned or staged during the postoperative period of the initial procedure.

4. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is used to avoid bundling issues.

5. Modifier 76 (Repeat Procedure or Service by Same Physician): Applied when the same procedure is repeated by the same physician after the initial procedure.

6. Modifier 77 (Repeat Procedure by Another Physician): Used when the same procedure is repeated by a different physician after the initial procedure.

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): Indicates an unplanned 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): Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

9. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required during the procedure.

10. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required for the procedure.

11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Indicates that an assistant surgeon was necessary because a qualified resident surgeon was not available.

12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): 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.

CPT Code 21387 Medicare Reimbursement

Medicare reimbursement for CPT code 21387, which pertains to the open treatment of an orbital fracture with a combined approach, depends on several factors including the specific Medicare plan, the setting in which the procedure is performed, and the geographical location. Generally, Medicare Part B covers medically necessary surgical procedures, including those involving the treatment of fractures.

To determine if CPT code 21387 is reimbursed by Medicare and the specific reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or the Ambulatory Surgical Center (ASC) Fee Schedule, depending on the setting. These schedules are updated annually and provide detailed information on the allowable amounts for various procedures.

For the most accurate and up-to-date information, providers can use the Medicare Physician Fee Schedule Look-Up Tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool allows providers to input the CPT code and obtain the reimbursement rates based on locality and other relevant factors.

In summary, while CPT code 21387 is generally reimbursable by Medicare, the exact amount and conditions for reimbursement can vary. Providers should consult the MPFS or ASC Fee Schedule for precise details.

Are You Being Underpaid for 21387 CPT Code?

Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 21387 for open treatment of orbit fractures. 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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