How To Use CPT Code 21076

CPT code 21076 describes the procedure for impression and custom preparation of a surgical obturator prosthesis. 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 21076?

CPT 21076 is used to describe the process of creating an impression and custom preparing a surgical obturator prosthesis. This code is used when a healthcare provider applies a substance that conforms to the patient’s intraoral structures to create an impression, which is then used to build a mold for the prosthesis. The prosthesis is designed to block a surgically created opening, such as the removal of the palate, and restore the patient’s ability to speak and swallow.

2. Official Description

The official description of CPT code 21076 is: ‘Impression and custom preparation surgical obturator prosthesis.’

3. Procedure

The procedure for CPT 21076 involves several steps:

1. The patient is appropriately prepped for the procedure.
2. The healthcare provider applies an irreversible hydrocolloid, a substance that forms a gel consistency when wet, to the area.
3. The hydrocolloid is allowed to harden sufficiently to create an impression.
4. Based on the impression, a mold is created.
5. The obturator prosthesis is prepared from a synthetic substance, such as self-curing acrylic resin.

4. Qualifying circumstances

CPT 21076 is used when the provider designs and prepares the surgical obturator prosthesis themselves, rather than having it prepared by an outside laboratory. This code is specifically for the impression and custom preparation of the prosthesis.

5. When to use CPT code 21076

CPT code 21076 should be used when a healthcare provider performs the impression and custom preparation of a surgical obturator prosthesis. It should not be used if the prosthesis is prepared by an outside laboratory.

6. Documentation requirements

To support a claim for CPT 21076, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for a surgical obturator prosthesis
• Details of the impression process, including the substance used and the hardening time
• Description of the mold creation process
• Information about the synthetic substance used to prepare the prosthesis

7. Billing guidelines

When billing for CPT 21076, ensure that the provider is performing the impression and custom preparation of the surgical obturator prosthesis themselves. This code should not be reported if the prosthesis is prepared by an outside laboratory.

8. Historical information

CPT 21076 was added to the Current Procedural Terminology system on January 1, 1996. There have been no updates to the code since its addition.

9. Similar codes to CPT 21076

There are several similar codes to CPT 21076 that describe different procedures related to prosthesis and maxillofacial surgery. These include:

• CPT 21077: Impression and custom preparation surgical obturator prosthesis, maxillary
• CPT 21078: Impression and custom preparation surgical obturator prosthesis, mandibular
• CPT 21079: Impression and custom preparation surgical obturator prosthesis, maxillary and mandibular
• CPT 21080: Impression and custom preparation surgical obturator prosthesis, maxillary, with soft tissue cast
• CPT 21081: Impression and custom preparation surgical obturator prosthesis, mandibular, with soft tissue cast

9. Examples

1. A patient undergoes surgery to remove part of their palate. The healthcare provider performs an impression and custom preparation of a surgical obturator prosthesis to restore the patient’s ability to speak and swallow.
2. Following maxillofacial surgery, a patient requires a surgical obturator prosthesis to separate exposed tissues from the contents of the mouth. The healthcare provider performs an impression and custom preparation of the prosthesis to facilitate faster healing and protect the exposed tissues.
3. A patient undergoes a procedure that results in a surgically created opening in their oral cavity. The healthcare provider performs an impression and custom preparation of a surgical obturator prosthesis to block the opening and restore normal function.
4. After the removal of the palate, a patient requires a surgical obturator prosthesis to maintain separation between the oral cavity and exposed tissues. The healthcare provider performs an impression and custom preparation of the prosthesis to ensure proper fit and function.
5. Following maxillofacial surgery, a patient needs a surgical obturator prosthesis to aid in the healing process and prevent contamination of exposed tissues. The healthcare provider performs an impression and custom preparation of the prosthesis to meet the patient’s specific needs.
6. A patient undergoes surgery that results in a surgically created opening in their oral cavity. The healthcare provider performs an impression and custom preparation of a surgical obturator prosthesis to restore normal function and protect the exposed tissues.
7. After the removal of the palate, a patient requires a surgical obturator prosthesis to separate the oral cavity from exposed tissues. The healthcare provider performs an impression and custom preparation of the prosthesis to ensure a proper fit and improve the patient’s quality of life.
8. Following maxillofacial surgery, a patient needs a surgical obturator prosthesis to facilitate healing and prevent contamination of exposed tissues. The healthcare provider performs an impression and custom preparation of the prosthesis to meet the patient’s specific anatomical requirements.
9. A patient undergoes a procedure that results in a surgically created opening in their oral cavity. The healthcare provider performs an impression and custom preparation of a surgical obturator prosthesis to restore normal function and protect the exposed tissues from external organisms.
10. After the removal of the palate, a patient requires a surgical obturator prosthesis to separate the oral cavity from exposed tissues and facilitate healing. The healthcare provider performs an impression and custom preparation of the prosthesis to ensure a comfortable fit and improve the patient’s quality of life.