How To Use CPT Code 21026

CPT 21026 describes the excision of bone in the facial area, typically performed to treat conditions such as osteomyelitis or bone abscess. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 21026?

CPT 21026 is a code used to describe the excision of bone in the facial area. This procedure is typically performed to treat conditions such as osteomyelitis or bone abscess. The provider removes the diseased bone to control the infection and prevent further spread.

2. Official Description

The official description of CPT code 21026 is: ‘Excision of bone (eg, for osteomyelitis or bone abscess) facial bone(s).’ This code is used when the provider performs a surgical excision of bone in the facial area to treat conditions such as osteomyelitis or bone abscess.

3. Procedure

The excision of bone procedure (CPT 21026) involves several steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision inside the mouth to minimize cosmetic damage from facial surgery.
3. The area is examined for the presence of necrotic tissue and an abscess cavity.
4. Purulent material is cleaned from the area.
5. The provider uses an osteotome or bone drill to remove the diseased bone tissue.
6. If there is extensive damage to the tissue, bone grafts may be used to compensate for the bone loss.
7. The infected area is treated with antimicrobial agents to stop the spread of the infection.
8. The oral incision is repaired using simple or layered sutures.

4. Qualifying circumstances

CPT 21026 is used for patients with conditions such as osteomyelitis or bone abscess in the facial area. The procedure is performed by a qualified healthcare professional. The provider must assess the patient’s condition and determine the need for bone excision. The procedure is typically performed to control the infection and prevent further spread.

5. When to use CPT code 21026

CPT code 21026 should be used when a qualified healthcare professional performs the excision of bone in the facial area to treat conditions such as osteomyelitis or bone abscess. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 21026, the healthcare professional must document the following information:

• Patient’s diagnosis, indicating the presence of osteomyelitis or bone abscess
• Details of the procedure, including the specific bone(s) excised
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures performed during the same session
• Any complications or unexpected findings
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 21026, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the details of the procedure and any additional procedures performed during the same session. Follow the appropriate coding and billing guidelines provided by the payer to ensure accurate reimbursement.

8. Historical information

CPT 21026 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient with osteomyelitis in the facial bone undergoes an excision procedure (CPT 21026) to remove the infected bone and control the infection.
2. A provider performs an excision of bone (CPT 21026) to treat a bone abscess in the maxilla of a patient.
3. A patient with osteomyelitis in the mandible undergoes an excision procedure (CPT 21026) to remove the infected bone and prevent further spread of the infection.
4. A provider performs an excision of bone (CPT 21026) to treat a bone abscess in the zygomatic arch of a patient.
5. A patient with osteomyelitis in the nasal bones undergoes an excision procedure (CPT 21026) to remove the infected bone and control the infection.