How To Use CPT Code 21030

CPT 21030 describes the excision of a benign tumor or cyst of the maxilla or zygoma by enucleation and curettage. 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 21030?

CPT 21030 is used to describe the surgical procedure of removing a benign tumor or cyst from the maxilla or zygoma. The procedure involves enucleation, which is the removal of the entire tumor as a single mass, and curettage, which is the scraping of diseased tissue using a curette.

2. Official Description

The official description of CPT code 21030 is: ‘Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage.’

3. Procedure

During the procedure, the patient is appropriately prepped and anesthetized. The provider makes an incision through the oral mucosa for an intraoral approach or through the skin of the face for an extraoral approach. The tumor on the maxilla or zygomatic arch bone is localized and marked for dissection. The provider then carefully removes the tumor in its entirety, ensuring that all traces of the tumor are scraped away using a curette. A tissue specimen is submitted for laboratory analysis. The provider checks for bleeding, removes any instruments, and closes the incision by suturing in a layered fashion.

4. Qualifying circumstances

CPT 21030 is used for the excision of benign tumors or cysts specifically located in the maxilla or zygoma. The procedure is performed by a qualified healthcare professional and is typically reserved for cases where the tumor or cyst is causing symptoms or poses a risk to the patient’s health. The decision to perform the procedure is based on the provider’s assessment of the patient’s condition and the need for surgical intervention.

5. When to use CPT code 21030

CPT code 21030 should be used when a provider performs the excision of a benign tumor or cyst located in the maxilla or zygoma. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If the excision is performed on a different facial bone or involves a different technique, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT 21030, the provider must document the following information:

• Patient’s diagnosis and the need for excision of the tumor or cyst
• Details of the procedure, including the approach used (intraoral or extraoral)
• Location and size of the tumor or cyst
• Details of the enucleation and curettage process
• Any complications or unexpected findings during the procedure
• Tissue specimen submission for laboratory analysis
• Details of the closure technique

7. Billing guidelines

When billing for CPT 21030, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately report the location of the tumor or cyst and the approach used for the excision. Modifier 47, Anesthesia by surgeon, may be used if the provider also administered anesthesia during the procedure. However, it is important to check with individual payers regarding their specific billing requirements and reimbursement policies.

8. Historical information

CPT 21030 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 21030

There are no similar codes to CPT 21030 within the Excision Procedures on the Head range (21011-21070).

9. Examples

1. A provider removes a benign maxillary cyst from a patient’s upper jaw using an intraoral approach.
2. A surgeon excises a benign tumor from the zygomatic arch bone through an extraoral approach.
3. A maxillofacial specialist performs the enucleation and curettage of a benign tumor in the maxilla using an intraoral approach.
4. A provider removes a cyst from the zygoma of a patient’s cheekbone using an extraoral approach.
5. An oral and maxillofacial surgeon performs the excision of a benign tumor from the maxilla through an intraoral approach.
6. A provider removes a maxillary cyst from the upper jaw of a patient using an extraoral approach.
7. A surgeon excises a benign tumor from the zygomatic arch bone through an intraoral approach.
8. A maxillofacial specialist performs the enucleation and curettage of a benign tumor in the maxilla using an extraoral approach.
9. A provider removes a cyst from the zygoma of a patient’s cheekbone using an intraoral approach.
10. An oral and maxillofacial surgeon performs the excision of a benign tumor from the maxilla through an extraoral approach.