How To Use CPT Code 21193

CPT code 21193 describes the surgical reconstruction of the mandibular rami, specifically the horizontal, vertical, C, or L osteotomy, without the use of 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 21193?

CPT 21193 is used to describe a surgical procedure that involves the reconstruction of the mandibular rami, which are the perpendicular portions of the lower jaw. This procedure is performed to correct facial deformities, often resulting from trauma. It specifically refers to the horizontal, vertical, C, or L osteotomy techniques, without the need for bone grafts.

2. Official Description

The official description of CPT code 21193 is: ‘Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy without bone graft.’

3. Procedure

During the procedure, the patient is appropriately prepped and anesthetized. The provider makes an incision along the jawline, either over the mandible or intraorally through the mouth. The incision is carried down to the ramus of the mandible on one side of the jaw. The provider then performs an osteotomy, which involves cutting into the bone in a horizontal, vertical, C, or L shape. Small burrs, such as spherical and cylindrical ones, are used to fracture the bone. The provider repositions the bone and secures it in place. The same procedure is repeated on the ramus of the opposite side of the jaw. After checking for bleeding and removing any instruments, the provider closes the incision with layered sutures.

4. Qualifying circumstances

CPT 21193 is used when the reconstruction of the mandibular rami does not require bone grafting. It is typically performed to correct facial deformities resulting from trauma. The procedure is performed by a qualified healthcare professional who has the necessary expertise in performing osteotomies and reconstructive procedures of the jaw.

5. When to use CPT code 21193

CPT code 21193 should be used when the surgical reconstruction of the mandibular rami is performed using the horizontal, vertical, C, or L osteotomy techniques, without the use of 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 21193, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for mandibular rami reconstruction
• Details of the specific osteotomy technique used (horizontal, vertical, C, or L)
• Date of the procedure
• Incision approach (over the mandible or intraoral)
• Any additional procedures performed during the same surgical session
• Any complications or unexpected findings
• Signature of the performing healthcare professional

7. Billing guidelines

When billing for CPT 21193, ensure that the procedure performed meets the specific criteria outlined in the code description. It is important to accurately document the details of the procedure and any additional services provided during the same surgical session. Modifier 52, Reduced services, may be used to indicate that the procedure was partially reduced at the provider’s discretion for unilateral cases. However, it is recommended to check with payers for specific guidelines regarding the reporting of unilateral procedures. If a midface distractor is applied in association with the procedure, modifier 22, Unusual procedural services, may be appended to indicate the additional work performed by the provider.

8. Historical information

CPT code 21193 was added to the Current Procedural Terminology system on January 1, 1991. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 21193

There are several similar codes to CPT 21193 that describe other repair, revision, and/or reconstruction procedures on the head. Some examples include:

• CPT 21120: Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy with bone graft
• CPT 21125: Reconstruction of mandibular rami, sagittal split osteotomy
• CPT 21206: Reconstruction of mandibular rami, segmental osteotomy
• CPT 21210: Reconstruction of mandibular rami, bilateral sagittal split osteotomy
• CPT 21296: Reconstruction of mandibular rami, bilateral segmental osteotomy

9. Examples

1. A patient undergoes surgical reconstruction of the mandibular rami using the horizontal osteotomy technique to correct a facial deformity resulting from trauma.
2. A provider performs a vertical osteotomy of the mandibular rami to reconstruct the jaw of a patient with a congenital facial deformity.
3. A healthcare professional performs a C-shaped osteotomy of the mandibular rami to correct a facial asymmetry caused by a previous injury.
4. A patient undergoes an L-shaped osteotomy of the mandibular rami to correct a malocclusion and improve their bite.
5. A provider performs a reconstruction of the mandibular rami without bone grafts using a combination of horizontal and vertical osteotomies to correct a severe facial deformity.
6. A patient undergoes surgical reconstruction of the mandibular rami using the horizontal osteotomy technique to correct a facial deformity resulting from a car accident.
7. A healthcare professional performs a vertical osteotomy of the mandibular rami to correct a facial asymmetry caused by a developmental disorder.
8. A provider performs a C-shaped osteotomy of the mandibular rami to correct a malocclusion and improve the patient’s ability to chew and speak.
9. A patient undergoes an L-shaped osteotomy of the mandibular rami to correct a facial deformity resulting from a previous surgery.
10. A provider performs a reconstruction of the mandibular rami without bone grafts using a combination of horizontal and vertical osteotomies to improve the patient’s facial aesthetics.