Wiki Mandible fracture guidance

[Kelly_Mayumi]

I have a surgeon that wants to report 21461 three times. I cannot find any guidance to say sure we can code per fracture in one bone or sorry, this is a complex fracture (which it sounds to me like a complex fracture).

Does anyone know where to find mandible fracture coding guidance?

 

[alambmichigan]

Hi Kelly,

If you have 3 fracture locations in the mandible, yes, you can bill for all three repairs using modifier 59 on each additional site. If they are placing fixation you will want to add modifier 52 to indicate to reduce reimbursement for only 1 set of arch bars being placed. Hope this helps.

Amy

 

[Kelly_Mayumi]

Yes it does, thank you.

 

[MCook]

21461 has a MUE of one. Make sure your documentation clearly supports all three repairs. Claims with units that exceed the MUE's are often denied/reviewed.

 

[alambmichigan]

I would be sure to code each individual fracture on its own line not a unit quantity, I have found the claim processes clean that way since you are indicating the 59 & 52 on the 2nd & third line.