How To Use CPT Code 21080

CPT 21080 describes the fabrication of an impression-based definitive obturator prosthesis to replace an interim prosthesis used after surgical resection of the upper jaw bone. 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 21080?

CPT 21080 is used to report the fabrication of a definitive obturator prosthesis, which replaces an interim prosthesis used to close a cavity created in the mouth after a partial or complete surgical resection of the upper jaw bone. This code is used when the patient has completed radiotherapy, the wounds have fully healed, and the oral cavity has a definitive shape.

2. Official Description

The official description of CPT code 21080 is: ‘Impression and custom preparation definitive obturator prosthesis.’

3. Procedure

1. The provider prepares the patient by ensuring that they have completed radiotherapy, the wounds have healed completely, and the oral cavity has a definitive shape.
2. The provider removes the interim obturator prosthesis and applies a substance that conforms to the shape of the oral cavity, allowing it to harden and create an impression.
3. Using the impression as a base model, the provider fabricates a definitive obturator prosthesis.
4. The provider inserts the definitive obturator prosthesis to replace the interim prosthesis.

4. Qualifying circumstances

CPT 21080 is used when the patient has completed radiotherapy, the wounds have healed completely, and the oral cavity has a definitive shape. The prosthesis must be designed and prepared by the provider, rather than an outside laboratory.

5. When to use CPT code 21080

CPT code 21080 should be used when the patient has completed radiotherapy, the wounds have healed completely, and the oral cavity has a definitive shape. It should only be reported when the provider actually designs and prepares the prosthesis, rather than having it prepared by an outside laboratory.

6. Documentation requirements

To support a claim for CPT 21080, the provider must document the following information:

• Completion of radiotherapy
• Complete healing of wounds
• Definitive shape of the oral cavity
• Removal of interim obturator prosthesis
• Impression of the oral cavity
• Fabrication of the definitive obturator prosthesis
• Insertion of the definitive obturator prosthesis

7. Billing guidelines

When billing for CPT 21080, ensure that the patient has completed radiotherapy, the wounds have healed completely, and the oral cavity has a definitive shape. It is important to note that CPT code 21080 should only be reported when the provider designs and prepares the prosthesis, rather than having it prepared by an outside laboratory.

8. Historical information

CPT 21080 was added to the Current Procedural Terminology system on January 1, 1991. There have been no updates to the code since its addition.

9. Examples

1. A patient who has completed radiotherapy and has fully healed wounds undergoes the fabrication of a definitive obturator prosthesis to replace an interim prosthesis used after surgical resection of the upper jaw bone.
2. A provider prepares a patient who has completed radiotherapy and has a definitive shape of the oral cavity for the fabrication of a definitive obturator prosthesis.
3. A patient who has completed radiotherapy and has fully healed wounds receives the insertion of a definitive obturator prosthesis to replace an interim prosthesis used after surgical resection of the upper jaw bone.
4. A provider designs and prepares a definitive obturator prosthesis for a patient who has completed radiotherapy and has a definitive shape of the oral cavity.
5. A patient who has completed radiotherapy and has fully healed wounds undergoes the impression and custom preparation of a definitive obturator prosthesis.
6. A provider inserts a definitive obturator prosthesis for a patient who has completed radiotherapy and has a definitive shape of the oral cavity.
7. A patient who has completed radiotherapy and has fully healed wounds receives the fabrication of a definitive obturator prosthesis to replace an interim prosthesis used after surgical resection of the upper jaw bone.
8. A provider prepares a patient who has completed radiotherapy and has a definitive shape of the oral cavity for the insertion of a definitive obturator prosthesis.
9. A patient who has completed radiotherapy and has fully healed wounds undergoes the impression and custom preparation of a definitive obturator prosthesis.
10. A provider designs and prepares a definitive obturator prosthesis for a patient who has completed radiotherapy and has a definitive shape of the oral cavity.