CPT Code 21610

CPT code 21610 is for the partial removal of a rib, used by healthcare providers for billing and documentation purposes.

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What is CPT Code 21610

CPT code 21610 is for the partial removal of a rib. This code is used by healthcare providers to document and bill for the surgical procedure where only a portion of a rib is removed, rather than the entire rib.

Does CPT 21610 Need a Modifier?

For CPT code 21610 (Partial removal of rib), the following modifiers may be applicable depending on the specific circumstances of the procedure:

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 50 - Bilateral Procedure: If the partial removal of the rib is performed on both sides of the body during the same operative session, this modifier should be used.

3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier indicates that multiple procedures were performed.

4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used to indicate 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 relevant if the procedure is not typically reported together but was necessary due to specific circumstances.

6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the partial removal of the rib within a short period, this modifier should be used.

7. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure within a short period, this modifier is applicable.

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 if the patient needs to 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: If an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure, this modifier should be used.

10. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left side of the body.

11. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right side of the body.

Each of these modifiers 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 21610 Medicare Reimbursement

Medicare does reimburse for the CPT code 21610, which pertains to the partial removal of a rib. The reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC), and whether the procedure is performed in a hospital outpatient setting or an ambulatory surgical center. As of the latest available data, the national average reimbursement rate for CPT code 21610 is approximately $1,200. However, it is essential to verify the exact reimbursement rate with your local MAC and consider any updates to the Medicare Physician Fee Schedule (MPFS) for the most accurate information.

Are You Being Underpaid for 21610 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 21610 for partial removal of rib. Schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer, ensuring you receive the full reimbursement you deserve.

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