How To Use CPT Code 21137

CPT code 21137 describes a procedure known as reduction forehead contouring. 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 21137?

CPT 21137 is a code used to describe the reduction forehead contouring procedure. This procedure involves contouring the forehead to reduce its size and lower the brow or hairline. It is performed by a healthcare provider to correct a facial abnormality or as a cosmetic surgery.

2. Official Description

The official description of CPT code 21137 is: ‘The provider contours the forehead to reduce the size of the forehead and lower the brow or hairline.’

3. Procedure

During the reduction forehead contouring procedure, the patient is appropriately prepped and anesthetized. The provider then makes an incision on the forehead, taking care to avoid injury to the frontal branches of the facial and supraorbital nerves. The incision is made down to the bone, exposing the irregular forehead areas. The provider uses high-speed drills and burrs to contour or shape the areas until the forehead looks smooth and no bone protrudes. Finally, the operative wound is closed with layered sutures.

4. Qualifying circumstances

Reduction forehead contouring is typically performed for cosmetic purposes. However, in some cases, it may be considered medically necessary to correct a facial abnormality. To ensure reimbursement for a medically necessary procedure, sufficient documentation must be provided to demonstrate the necessity of the surgery.

5. When to use CPT code 21137

CPT code 21137 should be used when a healthcare provider performs reduction forehead contouring to reduce the size of the forehead and lower the brow or hairline. It is important to note that most payers will not reimburse for this surgery if it is done solely for cosmetic purposes.

6. Documentation requirements

To support a claim for CPT code 21137, the healthcare provider must document the following information:

• The patient’s diagnosis or indication for the procedure
• A detailed description of the reduction forehead contouring procedure performed
• The date of the procedure
• Any complications or unusual findings during the procedure
• Post-operative care instructions, if applicable
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 21137, it is important to ensure that the procedure meets the necessary criteria for reimbursement. Most payers will not reimburse for reduction forehead contouring if it is performed solely for cosmetic purposes. To ensure payment for a medically necessary procedure, provide sufficient documentation to support the necessity of the surgery.

8. Historical information

CPT code 21137 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 code 21137

While there are no specific similar codes to CPT code 21137, there are other codes within the range of repair, revision, and/or reconstruction procedures on the head (21120-21296) that may be applicable for different procedures related to the head and neck region.

9. Examples

1. A patient undergoes reduction forehead contouring to correct a facial abnormality that has caused significant distress and functional impairment.
2. A healthcare provider performs reduction forehead contouring as part of a comprehensive facial reconstruction procedure for a patient with craniofacial abnormalities.
3. A patient undergoes reduction forehead contouring as a cosmetic procedure to achieve a desired aesthetic appearance.
4. A healthcare provider performs reduction forehead contouring to address asymmetry in the forehead and brow region caused by a previous injury.
5. A patient undergoes reduction forehead contouring to improve the proportion and balance of their facial features.
6. A healthcare provider performs reduction forehead contouring to correct a congenital forehead abnormality that has caused functional limitations.
7. A patient undergoes reduction forehead contouring to address the effects of aging and achieve a more youthful appearance.
8. A healthcare provider performs reduction forehead contouring as part of a gender-affirming procedure for a transgender individual.
9. A patient undergoes reduction forehead contouring to correct the effects of a previous unsuccessful forehead augmentation procedure.
10. A healthcare provider performs reduction forehead contouring to address the aesthetic concerns of a patient with a prominent forehead.