How To Use CPT Code 21089

CPT code 21089 describes an unlisted maxillofacial prosthetic procedure. 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 21089?

CPT 21089 is an unlisted maxillofacial prosthetic procedure code. It is used to report procedures that do not have a specific code available. This code is used when the provider fabricates a maxillofacial prosthetic that is not represented by any of the standard and active CPT codes.

2. Official Description

The official description of CPT code 21089 is: ‘Unlisted maxillofacial prosthetic procedure.’

3. Procedure

The procedure for CPT code 21089 involves the fabrication of a maxillofacial prosthetic that is not covered by any specific CPT code. This may include the creation of an artificial or man-made replacement for a body part related to the upper jaw and face. The specific steps and techniques used in the procedure will vary depending on the individual patient’s needs and the prosthetic being created.

4. Qualifying circumstances

CPT code 21089 can be used when there is no specific code available to accurately describe the maxillofacial prosthetic procedure being performed. It is important to note that CPT guidelines instruct against choosing a code that merely approximates the service provided. Therefore, if there is no specific procedure or service code that accurately represents the procedure, CPT 21089 should be used.

5. When to use CPT code 21089

CPT code 21089 should be used when there is no specific code available to accurately describe the maxillofacial prosthetic procedure being performed. It is important to thoroughly review the available codes and determine if there is a more specific code that can be used before resorting to the unlisted code. If no such specific procedure or service code exists, CPT 21089 should be reported.

6. Documentation requirements

When reporting CPT code 21089, it is crucial to provide detailed documentation to support the claim. This documentation should include a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Additionally, it is important to include one or more similar codes and compare the service to those codes to justify the claim amount being billed. Operative notes or other relevant documentation should also be included to strengthen the claim and avoid possible denial.

7. Billing guidelines

When billing for CPT code 21089, it is important to follow specific guidelines. CPT guidelines state that a Category III code should be reported when available in place of an unlisted procedure code. If there is no Category III code available, CPT 21089 should be used. It is important to submit a cover letter explaining the reason for using the unlisted code and provide supporting documentation to justify the claim amount being billed.

8. Historical information

CPT code 21089 was added to the Current Procedural Terminology system on January 1, 1991. There have been no updates to the code since its addition.

9. Similar codes to CPT 21089

While there are no specific similar codes to CPT code 21089, it is important to thoroughly review the available codes to ensure that there is no more specific code that can accurately describe the procedure being performed. If no such code exists, CPT 21089 should be used.

9. Examples

1. A maxillofacial prosthetic procedure involving the fabrication of a custom-made facial prosthesis for a patient with severe facial trauma.
2. The creation of an artificial nose for a patient who has undergone surgical removal of their natural nose due to cancer.
3. The fabrication of a custom-made ocular prosthesis for a patient who has lost an eye due to injury or disease.
4. A maxillofacial prosthetic procedure to create a custom-made mandibular prosthesis for a patient with a congenital jaw deformity.
5. The fabrication of a custom-made auricular prosthesis for a patient who has lost an ear due to trauma or surgery.
6. A maxillofacial prosthetic procedure to create a custom-made palatal obturator for a patient with a cleft palate.
7. The fabrication of a custom-made facial prosthesis for a patient with a congenital facial deformity.
8. A maxillofacial prosthetic procedure involving the creation of a custom-made prosthetic eye for a patient with anophthalmia.
9. The fabrication of a custom-made nasal prosthesis for a patient with a nasal defect caused by trauma or surgery.
10. A maxillofacial prosthetic procedure to create a custom-made prosthetic ear for a patient with microtia.