CPT Code 21627

CPT code 21627 is a medical billing code used to describe the procedure of sternal debridement, which involves the removal of damaged tissue from the sternum.

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What is CPT Code 21627

CPT code 21627 is used for the surgical procedure known as sternal debridement. This involves the removal of dead, damaged, or infected tissue from the sternum (breastbone) to promote healing and prevent further infection.

Does CPT 21627 Need a Modifier?

For CPT code 21627 (Sternal debridement), 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 sternal debridement procedure required significantly greater effort or complexity than typically required.

2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the sternal debridement was performed bilaterally.

3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, including sternal debridement, are performed during the same surgical session.

4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the sternal debridement was a distinct or independent service from other procedures performed on the same day.

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

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

7. Modifier 78 - Unplanned Return to the Operating Room
- This modifier is used if the patient required 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
- Apply this modifier if the sternal debridement was performed during the postoperative period of another procedure but is unrelated to the original procedure.

9. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the sternal debridement procedure.

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

11. 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.

12. 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 sternal debridement procedure.

Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.

CPT Code 21627 Medicare Reimbursement

Medicare does reimburse for CPT code 21627, which pertains to sternal debridement. The reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC), and the setting in which the procedure is performed (e.g., inpatient vs. outpatient). As of the latest available data, the national average reimbursement for CPT code 21627 is approximately $1,200. However, it is crucial to verify the exact reimbursement rate with your local MAC and consider any updates to the Medicare Physician Fee Schedule (MPFS) that may affect the amount.

Are You Being Underpaid for 21627 CPT Code?

Discover how MD Clarity's RevFind software can read your contracts and detect underpayments with pinpoint accuracy, down to the CPT code level and by individual payer. For example, ensure you're receiving full reimbursement for CPT code 21627, Sternal debridement. Schedule a demo today to see how RevFind can optimize your revenue cycle and secure the payments you deserve.

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