How To Use CPT Code 21085

CPT 21085 describes the impression and custom preparation of an oral surgical splint. 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 21085?

CPT 21085 is used to describe the process of creating an oral surgical splint that matches the patient’s facial contours. This involves taking an impression, or negative imprint, of the patient’s face and using it as a base model to fabricate the splint. The splint is designed to support the patient’s facial structures during orthognathic reconstruction or other oral surgeries, such as when the mandible has been removed due to trauma or ablative surgery.

2. Official Description

The official description of CPT code 21085 is: ‘Impression and custom preparation oral surgical splint.’

3. Procedure

The procedure for CPT 21085 involves several steps:

1. The provider applies a substance that conforms to the shape of the area of the face where the surgery will take place.
2. Once the substance has hardened sufficiently, an impression of the patient’s face is created.
3. Using the impression as a base model, the provider fabricates an oral surgical splint from a material like polymethyl methacrylate.
4. The provider then inserts the oral surgical splint to support the patient’s facial structures during the surgical procedure.

4. Qualifying circumstances

CPT 21085 is used when the provider designs and prepares the oral surgical splint themselves, rather than having it prepared by an outside laboratory. It is important to note that individual carrier reporting guidelines may vary, so it is essential to review the specific guidelines of the patient’s carrier to ensure accurate reporting.

5. When to use CPT code 21085

CPT code 21085 should be used when the provider is responsible for both the design and preparation of the oral surgical splint. If the splint is prepared by an outside laboratory, a different code should be used. Additionally, the appropriate code for creating an orthognathic splint may vary depending on whether the procedure is reported as a dental or medical claim. It is important to review the specific guidelines of the patient’s carrier to determine the correct code for reporting.

6. Documentation requirements

To support a claim for CPT 21085, the provider must document the following information:

• The need for the oral surgical splint and the specific surgical procedure being performed
• The impression of the patient’s face and the material used to create the splint
• The date and time of the procedure
• Any additional details or modifications made to the splint
• The provider’s signature

7. Billing guidelines

When billing for CPT 21085, it is important to ensure that the provider is responsible for both the design and preparation of the oral surgical splint. If the splint is prepared by an outside laboratory, a different code should be used. It is also important to review the specific guidelines of the patient’s carrier to determine the correct code for reporting, as individual carrier guidelines may vary.

8. Historical information

CPT 21085 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

Here are some examples of cases where CPT code 21085 may be billed:

1. A patient undergoing orthognathic reconstruction requires an oral surgical splint to support their facial structures during the procedure.
2. A patient who has had their mandible removed due to ablative surgery requires an oral surgical splint to support their facial structures.
3. A patient undergoing a complex oral surgery procedure requires an oral surgical splint to aid in the surgical process.
4. A patient with a facial deformity requires an oral surgical splint to assist in the reconstruction of their facial structures.
5. A patient undergoing a reconstructive procedure following trauma to the face requires an oral surgical splint to support their facial structures.