How To Use CPT Code 21050

CPT code 21050 describes the surgical excision of the rounded ends of the mandible, specifically where they connect to the temporomandibular joint (TMJ). 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 21050?

CPT 21050 is used to describe the surgical procedure known as condylectomy. This procedure involves the removal of the rounded ends of the mandible, specifically where they connect to the temporomandibular joint (TMJ). It is typically performed to treat dislocated or diseased condyles that interfere with the movement of the joint or cause pain.

2. Official Description

The official description of CPT code 21050 is: ‘Condylectomy, temporomandibular joint (separate procedure).’ If the procedure is performed bilaterally, modifier 50 should be appended to the code.

3. Procedure

During a condylectomy, the provider begins by making a curvilinear incision in front of the tragus line, which is an anatomical landmark in front of the ear. They then dissect and retract the fascia and underlying muscles to expose the temporomandibular joint (TMJ). The provider identifies the TMJ joint and uses a bone drill or osteotome to remove the diseased or restrictive part of the condyle. The dissected condyle is then removed using surgical forceps. The provider assesses the movement of the jaw and applies a bone graft or synthetic graft material to fill the defect left by the condylectomy. Finally, they check for bleeding, remove any instruments, and close the incision by suturing in a complex layered fashion.

4. Qualifying circumstances

CPT code 21050 is typically used for patients who have dislocated or diseased condyles that interfere with the movement of the temporomandibular joint (TMJ) or cause pain. The procedure is performed by a qualified healthcare professional and may require the use of bone grafting to fill the defect left by the condylectomy.

5. When to use CPT code 21050

CPT code 21050 should be used when a provider performs a condylectomy, specifically targeting the temporomandibular joint (TMJ). It is important to ensure that the procedure is performed separately from any other procedures and that modifier 50 is appended if the procedure is performed bilaterally.

6. Documentation requirements

To support a claim for CPT code 21050, the provider must document the following information:

• Patient’s diagnosis and the need for a condylectomy
• Preoperative radiological studies of the condyles
• Date of the procedure
• Details of the procedure, including the specific steps taken
• Use of bone graft or synthetic graft material, if applicable
• Assessment of jaw movement
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT code 21050, it is important to ensure that the procedure is performed separately from any other procedures. If the procedure is performed bilaterally, modifier 50 should be appended to the code. It is also important to follow any specific billing guidelines provided by the payer.

8. Historical information

CPT code 21050 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 21050

There are several similar codes to CPT code 21050 that describe excision procedures on the head. These include:

• CPT 21011: Excision of tumor or cyst of mandible
• CPT 21025: Excision of tumor or cyst of maxilla
• CPT 21030: Excision of tumor or cyst of zygoma
• CPT 21040: Excision of tumor or cyst of palate
• CPT 21070: Excision of tumor or cyst of floor of mouth

9. Examples

1. A patient undergoes a condylectomy to treat a dislocated condyle in their temporomandibular joint (TMJ).
2. A provider performs a condylectomy on a patient with a diseased condyle that is causing severe pain and limiting jaw movement.
3. A condylectomy is performed on a patient with TMJ ankylosis, a condition that leads to fusion of the joint following an injury or infection.
4. A provider performs a bilateral condylectomy on a patient with bilateral dislocated condyles in their TMJ.
5. A patient undergoes a condylectomy with bone grafting to fill the defect left by the excised condyle.
6. A provider performs a condylectomy as part of a larger surgical procedure to treat a complex temporomandibular joint disorder.
7. A condylectomy is performed on a patient with a large tumor involving the condyle of the mandible.
8. A provider performs a condylectomy on a patient with recurrent dislocations of the TMJ.
9. A patient undergoes a condylectomy to alleviate chronic pain and improve jaw function.
10. A condylectomy is performed on a patient with a congenital abnormality of the mandible affecting the condyles.