How To Use CPT Code 21146

CPT code 21146 describes the reconstruction of the midface using a LeFort I procedure, which involves moving the maxilla and associated bones forward and may require bone grafts. 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 21146?

CPT 21146 is used to describe the reconstruction of the midface using a LeFort I procedure. This surgical technique involves repositioning the maxilla, or upper jaw bone, and associated bones to correct congenital or acquired deformities. The procedure may also require bone grafts to fill defects and obtain autografts from the patient’s own body.

2. Official Description

The official description of CPT code 21146 is: ‘Reconstruction midface, LeFort I 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)’

3. Procedure

In a LeFort I midface surgery, the provider reconstructs the patient’s facial bones using microsurgery and bone grafting to correct congenital deformities or acquired deformities. The provider moves the maxilla, or upper jaw bone, and associated bones forward, repositioning the teeth-bearing part of the maxilla.

When performing the procedure, the provider typically follows these steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the site chosen for harvesting a bone graft and removes sufficient autograft.
3. The provider makes an incision in the maxillary area and separates the maxilla from the skull base.
4. The provider repositions the maxilla into the appropriate, predetermined location and repositions two predetermined bone segments into place.
5. The provider fills the defect with bone graft material previously harvested.
6. If required, the provider molds and shapes a dental appliance to the defect intraoperatively, which can be reduced as an outpatient as the defect contracts.
7. The provider packs the cavity with surgical gauze or a similar material and positions a palatal obturator, securing it in place with a single screw through the residual hard palate.
8. The provider checks for bleeding, removes any instruments, and closes the incision with layered sutures.

4. Qualifying circumstances

CPT 21146 is typically performed on patients with congenital or acquired midface deformities that require reconstruction. One example of a qualifying circumstance is an ungrafted unilateral alveolar cleft, which is a congenital defect where a gap occurs in the tooth-bearing portion of the jaw bone. The procedure may also involve bone grafting, which is the surgical replacement of missing bones with material from the patient’s own body or a substitute.

5. When to use CPT code 21146

CPT code 21146 should be used when a provider performs a LeFort I midface reconstruction procedure involving the movement of two bone segments in any direction and requiring bone grafts. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 21146, the provider must document the following information:

• Patient’s diagnosis and the need for midface reconstruction
• Details of the LeFort I procedure, including the movement of two bone segments and the use of bone grafts
• Date of the procedure
• Start and end time of the procedure
• Specific techniques used during the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 21146, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The provider should also follow any additional billing guidelines provided by the payer. It is recommended to obtain preauthorization for the procedure to indicate medical necessity.

8. Historical information

CPT code 21146 was added to the Current Procedural Terminology system on January 1, 1991. There have been several historical changes to the code, including updates to the code description and its inclusion or exclusion from the Inpatient Only (IPO) list for Medicare reimbursement.

9. Similar codes to CPT 21146

There are several similar codes to CPT 21146 that describe other types of midface reconstruction procedures. These codes include:

• CPT 21120: Reconstruction midface, LeFort I; single piece
• CPT 21121: Reconstruction midface, LeFort I; 2 pieces
• CPT 21122: Reconstruction midface, LeFort I; 3 pieces
• CPT 21125: Reconstruction midface, LeFort I; 4 or more pieces
• CPT 21296: Reconstruction midface, LeFort I; with bone graft (includes obtaining graft)

9. Examples

1. A patient with a congenital midface deformity undergoes a LeFort I reconstruction procedure to reposition the maxilla and associated bones.
2. A provider performs a LeFort I procedure on a patient with an acquired midface deformity resulting from trauma.
3. A patient with an ungrafted unilateral alveolar cleft undergoes a LeFort I reconstruction procedure with bone grafts.
4. A provider performs a LeFort I procedure on a patient with a congenital midface deformity, repositioning two bone segments in any direction.
5. A patient with a severe midface deformity undergoes a LeFort I reconstruction procedure involving the movement of two bone segments and requiring bone grafts.
6. A provider performs a LeFort I procedure on a patient with a complex midface deformity, reconstructing multiple bone pieces.
7. A patient with a congenital midface deformity undergoes a LeFort I reconstruction procedure with bone grafts obtained from the patient’s own body.
8. A provider performs a LeFort I procedure on a patient with an acquired midface deformity, repositioning the maxilla and associated bones.