How To Use CPT Code 21034

CPT code 21034 describes the excision of a malignant tumor of the maxilla or zygoma, which are the upper jaw bone and cheekbone, respectively. 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 21034?

CPT 21034 is used to describe the surgical removal of a malignant tumor located in the maxilla or zygoma. The procedure involves an open surgical approach, which can be either intraoral (through the mouth) or extraoral (through the skin). The provider will make an incision, locate the tumor, remove it along with surrounding margins, and close the incision with sutures.

2. Official Description

The official description of CPT code 21034 is: ‘Excision of malignant tumor of maxilla or zygoma.’

3. Procedure

During the procedure for CPT 21034, the provider will:

1. Make an incision through the oral mucosa or skin, depending on the approach.
2. Locate the tumor in the maxilla or zygoma.
3. Mark the tumor and surrounding margins for dissection.
4. Use a bone drill or osteotome to cut and remove the tumor and surrounding bone.
5. Scrape surrounding tissues with a curette to ensure complete removal of the malignant tumor.
6. Submit a tissue specimen for laboratory analysis.
7. Check for bleeding, remove any instruments, and close the incision with sutures.

4. Qualifying circumstances

CPT 21034 is used for the excision of a malignant tumor in the maxilla or zygoma. The procedure is performed when the tumor is cancerous and requires surgical removal. The provider must ensure that the patient is appropriately prepped and anesthetized before proceeding with the excision.

5. When to use CPT code 21034

CPT code 21034 should be used when a provider performs the excision of a malignant tumor in the maxilla or zygoma. It is important to note that this code is not appropriate for benign tumors or tumors located in other facial bones. If the tumor is located in a different facial bone, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT 21034, the provider must document the following information:

• Patient’s diagnosis of a malignant tumor in the maxilla or zygoma
• Approach used for the excision (intraoral or extraoral)
• Date of the procedure
• Details of the procedure, including the incision, tumor removal, and closure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 21034, ensure that the excision is performed on a malignant tumor in the maxilla or zygoma. It is important to use the appropriate approach modifier (intraoral or extraoral) to indicate the method used for the excision. Modifier 59 should be used if separate tumors are excised on both the left and right sides of the maxilla. Do not use modifier 50, as the maxilla is not considered a bilateral structure.

8. Historical information

CPT 21034 was added to the Current Procedural Terminology system on January 1, 1990. It was initially described as the excision of a malignant tumor of a facial bone other than the mandible. The code description was revised on January 1, 2003, to specifically include the maxilla and zygoma.

9. Examples

1. A provider performs the excision of a malignant tumor in the maxilla through an intraoral approach.
2. A patient undergoes the excision of a malignant tumor in the zygoma through an extraoral approach.
3. A provider removes a malignant tumor in the maxilla and performs a separate excision of a tumor in the zygoma during the same procedure.
4. A patient undergoes the excision of a malignant tumor in the maxilla, and the provider submits a tissue specimen for laboratory analysis.
5. A provider performs the excision of a malignant tumor in the zygoma, ensuring complete removal of the tumor and surrounding margins.
6. A patient undergoes the excision of a malignant tumor in the maxilla, and the provider closes the incision with sutures in a layered fashion.
7. A provider performs the excision of a malignant tumor in the zygoma, checking for bleeding and removing any instruments before closing the incision.
8. A patient undergoes the excision of a malignant tumor in the maxilla, and the provider documents the details of the procedure, including the incision and tumor removal.
9. A provider performs the excision of a malignant tumor in the zygoma, documenting any complications encountered during the procedure.
10. A patient undergoes the excision of a malignant tumor in the maxilla, and the provider signs the documentation to support the claim for CPT 21034.