How To Use CPT Code 21235

CPT 21235 refers to an autogenous ear cartilage graft procedure used to repair deformities in the nose or ear. This article will cover the description, procedure, qualifying circumstances, billing guidelines, documentation requirements, historical information, similar codes, and examples of CPT 21235.

1. What is CPT 21235?

CPT 21235 is a medical procedure code that describes the use of an autogenous ear cartilage graft to repair deformities in the nose or ear. This procedure is typically performed to correct issues resulting from fractures, injuries, tumor resections, or congenital defects. The code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 21235 CPT code description

The official description of CPT code 21235 is: “Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)”.

3. Procedure

The 21235 CPT code procedure involves the following steps:

1. The patient is prepped and anesthetized.
2. The provider makes an incision on the back side of the ear and removes the central portion of the ear cartilage from beneath the skin, taking care not to alter the overall shape of the ear.
3. The provider incises the area on the nose or ear that will receive the graft.
4. The graft is positioned in place and all wounds are closed.
5. If the graft is applied to the nose, a subsequent rhinoplasty is performed to achieve a satisfactory cosmetic appearance.

4. Qualifying circumstances

Patients eligible to receive CPT code 21235 services are those who require an autogenous ear cartilage graft to repair deformities in the nose or ear due to fractures, injuries, tumor resections, or congenital defects. In many cases, this procedure is performed for cosmetic purposes, and most insurers do not reimburse for cosmetic procedures. However, if the procedure is performed for medically necessary reasons, preauthorization should be obtained to alert the insurer of the medical necessity of the procedure.

5. When to use CPT code 21235

It is appropriate to bill the 21235 CPT code when the provider performs an autogenous ear cartilage graft procedure to repair deformities in the nose or ear due to medically necessary reasons. This code should not be used for cosmetic procedures, as most insurers do not reimburse for cosmetic services.

6. Documentation requirements

To support a claim for CPT 21235, the following information should be documented:

• A detailed description of the patient’s condition and the medical necessity for the procedure.
• Preauthorization from the insurer, if required.
• A step-by-step description of the procedure performed, including the incision sites, graft harvesting, graft placement, and wound closure.
• Any complications or additional procedures performed during the surgery.
• Postoperative care instructions and follow-up appointments.

7. Billing guidelines

When billing for CPT code 21235, it is important to follow these guidelines:

• Obtain preauthorization from the insurer if the procedure is performed for medically necessary reasons.
• Do not use this code for cosmetic procedures, as most insurers do not reimburse for cosmetic services.
• Ensure that all documentation requirements are met to support the claim.
• Do not use this code in association with a reconstructive procedure that includes graft harvesting, such as tympanoplasty or myringoplasty, even if the graft is obtained through a separate incision. An exception is when a prior surgical procedure requires the provider to obtain the graft from the opposite ear. In these cases, append modifier 59, Distinct procedural service, to 21235.

8. Historical information

CPT 21235 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 21235

Five similar codes to CPT 21235 and how they differentiate are:

• CPT 21208: This code is used for graft augmentation of facial bones, not for ear cartilage grafts.
• CPT 21210: This code describes grafting of the nasal septum, not the ear cartilage.
• CPT 21215: This code is used for grafting of the mandible, not the ear cartilage.
• CPT 21230: This code describes rib cartilage grafting, not ear cartilage grafting.
• CPT 21260: This code is used for orbital decompression, not ear cartilage grafting.

10. Examples

Here are 10 detailed examples of CPT code 21235 procedures:

1. A patient with a congenital ear deformity undergoes an autogenous ear cartilage graft to improve the appearance and function of the ear.
2. A patient who suffered a nasal fracture in an accident requires an ear cartilage graft to repair the damage and restore the nose’s appearance and function.
3. A patient with a history of skin cancer has a tumor resected from their ear, resulting in a deformity that requires an autogenous ear cartilage graft for reconstruction.
4. A patient with a congenital nasal deformity undergoes an ear cartilage graft to improve the appearance and function of the nose.
5. A patient who suffered a traumatic injury to the ear requires an autogenous ear cartilage graft to repair the damage and restore the ear’s appearance and function.
6. A patient with a history of nasal cancer has a tumor resected from their nose, resulting in a deformity that requires an ear cartilage graft for reconstruction.
7. A patient with a congenital ear deformity undergoes a second autogenous ear cartilage graft after the initial graft failed to achieve the desired results.
8. A patient who suffered a nasal fracture in a sports accident requires an ear cartilage graft to repair the damage and restore the nose’s appearance and function.
9. A patient with a history of skin cancer has a second tumor resected from their ear, resulting in a deformity that requires an autogenous ear cartilage graft for reconstruction.
10. A patient with a congenital nasal deformity undergoes a second ear cartilage graft after the initial graft failed to achieve the desired results.