How To Use CPT Code 21196

CPT code 21196 describes the surgical reconstruction of the body of the mandible, or lower jaw, and/or its rami, using a sagittal split osteotomy technique with internal rigid fixation. 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 21196?

CPT code 21196 is used to describe the surgical reconstruction of the mandible, specifically the body and/or rami, to correct facial deformities, often resulting from trauma. This procedure involves making an incision along the jaw line, either over the mandible or intraorally through the mouth. The provider then performs a sagittal split osteotomy, dividing the jaw into anterior and posterior portions. The bone is repositioned, aligned correctly, and secured in place using plate and screw fixation. This code is inherently bilateral, but modifier 52 may be used to indicate a unilateral procedure.

2. Official Description

The official description of CPT code 21196 is: ‘Reconstruction of mandibular rami and/or body, sagittal split with internal rigid fixation.’

3. Procedure

During the procedure for CPT code 21196, the provider begins by making an incision along the jaw line, either over the mandible or intraorally through the mouth. This incision is carried down to the mandible and/or the ramus area on one side of the jaw. The provider then performs a sagittal split osteotomy, using small burrs to fracture the bone. The jaw is divided into anterior and posterior portions. The bone is repositioned, ensuring correct alignment, and secured in place using plate and screw fixation. The procedure is repeated on the opposite side of the jaw. Finally, the provider checks for bleeding, removes any instruments, and closes the incision with layered sutures.

4. Qualifying circumstances

CPT code 21196 is typically performed on patients with facial deformities resulting from trauma. The procedure is indicated when there is a need for surgical reconstruction of the mandibular rami and/or body. It is important to note that this code is inherently bilateral, but modifier 52 may be used to indicate a unilateral procedure if necessary.

5. When to use CPT code 21196

CPT code 21196 should be used when a provider performs surgical reconstruction of the mandibular rami and/or body using a sagittal split osteotomy technique with internal rigid fixation. This code is appropriate for correcting facial deformities resulting from trauma. It is important to ensure that the documentation supports the use of this specific code and that the procedure meets the criteria outlined in the official description.

6. Documentation requirements

To support a claim for CPT code 21196, the provider must document the following information:

• Patient’s diagnosis and the need for surgical reconstruction
• Details of the procedure performed, including the use of a sagittal split osteotomy and internal rigid fixation
• Incision location (along the jaw line or intraorally)
• Specific areas of the mandible and/or rami addressed
• Use of plate and screw fixation for securing the bone
• Any additional procedures performed during the same surgical session
• Unilateral or bilateral nature of the procedure, if applicable
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 21196, ensure that the procedure meets the criteria outlined in the official description. This code is inherently bilateral, but modifier 52 may be used to indicate a unilateral procedure. It is important to follow the guidelines provided by payers regarding the reporting of unilateral procedures. Additionally, it is essential to review any specific billing guidelines or requirements from individual payers to ensure accurate and appropriate reimbursement.

8. Historical information

CPT code 21196 was added to the Current Procedural Terminology system on January 1, 1991. It has undergone several changes in terms of its inclusion in the Inpatient Only (IPO) list for Medicare. As of 2023, it is no longer included in the IPO list.

9. Similar codes to CPT 21196

While there are no specific similar codes to CPT code 21196, 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 involving the head and neck region. It is important to review the code range and select the most appropriate code based on the specific procedure performed.

9. Examples

1. A patient undergoes surgical reconstruction of the mandibular rami and body using a sagittal split osteotomy technique with internal rigid fixation to correct facial deformities resulting from a traumatic injury.
2. A provider performs bilateral sagittal split osteotomy with internal rigid fixation to reconstruct the mandibular rami and body in a patient with congenital jaw deformities.
3. During a surgical procedure, a provider performs a unilateral sagittal split osteotomy with internal rigid fixation to reconstruct the mandibular rami and body on one side of the jaw in a patient with facial asymmetry.
4. A patient undergoes surgical reconstruction of the mandibular rami and body using a sagittal split osteotomy technique with internal rigid fixation to correct facial deformities resulting from a previous failed jaw surgery.
5. A provider performs bilateral sagittal split osteotomy with internal rigid fixation to reconstruct the mandibular rami and body in a patient with severe mandibular hypoplasia.
6. During a surgical procedure, a provider performs a unilateral sagittal split osteotomy with internal rigid fixation to reconstruct the mandibular rami and body on one side of the jaw in a patient with a history of mandibular fracture.
7. A patient undergoes surgical reconstruction of the mandibular rami and body using a sagittal split osteotomy technique with internal rigid fixation to correct facial deformities resulting from a genetic condition.
8. A provider performs bilateral sagittal split osteotomy with internal rigid fixation to reconstruct the mandibular rami and body in a patient with temporomandibular joint dysfunction.
9. During a surgical procedure, a provider performs a unilateral sagittal split osteotomy with internal rigid fixation to reconstruct the mandibular rami and body on one side of the jaw in a patient with a history of oral cancer.