How To Use CPT Code 21159

CPT code 21159 describes the reconstruction of the midface, specifically the LeFort III procedure, which involves the advancement of the forehead and requires 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 21159?

CPT 21159 is a code used to describe the reconstruction of the midface, specifically the LeFort III procedure. This procedure involves extensive reconstruction of the facial bones, including the advancement of the forehead, using microsurgery and bone grafting. It is typically performed to correct deformities, whether acquired or congenital, such as Apert Syndrome.

2. Official Description

The official description of CPT code 21159 is: ‘Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts) without LeFort I.’

3. Procedure

The LeFort III procedure, represented by CPT code 21159, involves several steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the site chosen for harvesting a bone graft, typically the hip bone, and removes sufficient autograft.
3. Incisions are made in the mouth, behind the lower eyelids, and/or through the skin below the lower eyelids.
4. The nose is incised using a bicoronal approach, and the scalp is raised forward to gain access to the nasal bones.
5. Sensory nerves to the forehead are freed from their bony canals.
6. The provider repositions the bones in a predetermined fashion until the desired appearance is achieved.
7. The forehead is advanced using a mono bloc technique.
8. Any gaps are filled in with the previously harvested bone graft material.
9. Suction drains are placed in the scalp to reduce bruising.
10. The provider checks for bleeding, removes any instruments, and closes the incision with layered sutures.

4. Qualifying circumstances

CPT code 21159 is used for patients who require extensive midface reconstruction, specifically the LeFort III procedure. This procedure is typically performed to correct significant facial deformities, whether acquired or congenital, such as Apert Syndrome. It may involve the use of bone grafts obtained from the patient’s own body (autografts).

5. When to use CPT code 21159

CPT code 21159 should be used when a provider performs the LeFort III procedure, which involves the reconstruction of the midface, including the advancement of the forehead and the use of bone grafts. This code should not be used if the LeFort I procedure is performed instead.

6. Documentation requirements

To support a claim for CPT code 21159, the provider must document the following information:

• The patient’s diagnosis and the need for midface reconstruction
• The specific details of the procedure performed, including the use of bone grafts
• The date of the procedure
• The start and end time of the procedure
• Any additional details or complications encountered during the procedure
• The provider’s signature

7. Billing guidelines

When billing for CPT code 21159, it is important to ensure that the procedure performed meets the criteria for midface reconstruction, specifically the LeFort III procedure. This code should not be reported if the LeFort I procedure is performed instead. It is also important to follow any preauthorization requirements set by the insurer to ensure proper reimbursement.

8. Historical information

CPT code 21159 was added to the Current Procedural Terminology system on January 1, 1991. It has undergone changes in its status as an inpatient-only (IPO) procedure, being removed from the IPO list in 2021 but added back in 2022.

9. Similar codes to CPT 21159

There are several similar codes to CPT code 21159 that involve repair, revision, and/or reconstruction procedures on the head. Some examples include:

• CPT 21120: Reconstruction midface, LeFort I (eg, advancement, widening, shortening)
• CPT 21121: Reconstruction midface, LeFort II (eg, advancement, widening, shortening)
• CPT 21122: Reconstruction midface, LeFort I and II (eg, advancement, widening, shortening)
• CPT 21295: Reconstruction midface, LeFort I (eg, advancement, widening, shortening); with bone graft (includes obtaining graft)
• CPT 21296: Reconstruction midface, LeFort II (eg, advancement, widening, shortening); with bone graft (includes obtaining graft)

9. Examples

1. A patient with Apert Syndrome undergoing a LeFort III procedure to correct significant facial deformities.
2. A patient with a congenital midface deformity requiring the advancement of the forehead and bone grafts.
3. A patient with acquired facial deformities due to trauma undergoing midface reconstruction with the LeFort III procedure.
4. A patient with craniofacial dysostosis requiring extensive midface reconstruction, including the advancement of the forehead.
5. A patient with a severe congenital anomaly requiring the LeFort III procedure to correct significant facial deformities.
6. A patient with a complex midface deformity undergoing reconstruction with the LeFort III procedure and bone grafts.
7. A patient with a history of failed previous midface reconstruction undergoing revision with the LeFort III procedure.
8. A patient with a congenital midface deformity requiring the advancement of the forehead and bone grafts.
9. A patient with acquired facial deformities due to trauma undergoing midface reconstruction with the LeFort III procedure.
10. A patient with craniofacial dysostosis requiring extensive midface reconstruction, including the advancement of the forehead.