How To Use CPT Code 21087

CPT 21087 describes the fabrication of a nasal prosthesis by taking an impression of the patient’s nasal area. 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 21087?

CPT 21087 is used to describe the process of fabricating a nasal prosthesis for patients who have a partially or totally missing nose due to surgery, trauma, or a congenital defect. The provider takes an impression of the patient’s nasal area and uses it as a base model to create a wax model. The final prosthesis is then made using a synthetic material such as silicone.

2. Official Description

The official description of CPT code 21087 is: ‘Impression and custom preparation nasal prosthesis.’

3. Procedure

1. The provider applies irreversible hydrocolloid, a gel-like substance, to the patient’s nasal area to create an impression of the nasal defect and adjacent tissue.
2. Once the hydrocolloid has hardened, the provider uses the impression as a base model to fabricate a wax model.
3. The provider sculpts the wax model, taking into account the patient’s general appearance and previous photographs.
4. The final prosthesis is created using a synthetic material, typically silicone.
5. The provider positions the nasal prosthesis on the patient.

4. Qualifying circumstances

CPT 21087 should only be used when the provider designs and prepares the nasal prosthesis themselves, rather than having it prepared by an outside laboratory.

5. When to use CPT code 21087

CPT code 21087 should be used when a provider is directly involved in the fabrication of a nasal prosthesis by taking an impression and custom preparing the prosthesis. It should not be used if the prosthesis is prepared by an outside laboratory.

6. Documentation requirements

To support a claim for CPT 21087, the provider must document the following information:

• Patient’s condition and the need for a nasal prosthesis
• Details of the impression taken and the materials used
• Description of the fabrication process, including the creation of the wax model and the use of synthetic materials
• Date of the procedure
• Positioning of the nasal prosthesis on the patient

7. Billing guidelines

When billing for CPT 21087, ensure that the provider is directly involved in the fabrication of the nasal prosthesis. It should not be reported if the prosthesis is prepared by an outside laboratory. There are no specific guidelines regarding reporting CPT 21087 with other codes.

8. Historical information

CPT 21087 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 undergone nasal surgery requires a custom nasal prosthesis. The provider takes an impression of the patient’s nasal area and fabricates a prosthesis using a synthetic material.
2. A patient with a congenital defect that has resulted in a missing nose needs a nasal prosthesis. The provider takes an impression and creates a custom prosthesis to replace the missing nasal area.
3. A patient who has experienced trauma resulting in a partially missing nose requires a nasal prosthesis. The provider takes an impression and fabricates a prosthesis to restore the missing nasal area.
4. A patient who has undergone multiple surgeries resulting in a completely missing nose needs a custom nasal prosthesis. The provider takes an impression and creates a prosthesis to replace the entire nasal area.
5. A patient with a congenital defect that has left them without a nose requires a custom nasal prosthesis. The provider takes an impression and fabricates a prosthesis to restore the missing nasal area.
6. A patient who has undergone nasal surgery requires a custom nasal prosthesis. The provider takes an impression of the patient’s nasal area and fabricates a prosthesis using a synthetic material.
7. A patient with a congenital defect that has resulted in a missing nose needs a nasal prosthesis. The provider takes an impression and creates a custom prosthesis to replace the missing nasal area.
8. A patient who has experienced trauma resulting in a partially missing nose requires a nasal prosthesis. The provider takes an impression and fabricates a prosthesis to restore the missing nasal area.
9. A patient who has undergone multiple surgeries resulting in a completely missing nose needs a custom nasal prosthesis. The provider takes an impression and creates a prosthesis to replace the entire nasal area.
10. A patient with a congenital defect that has left them without a nose requires a custom nasal prosthesis. The provider takes an impression and fabricates a prosthesis to restore the missing nasal area.