How To Use CPT Code 21230

CPT code 21230 describes the procedure of grafting autogenous rib cartilage to the face, including the chin, nose, or ear, to repair deformities caused by fractures, injuries, tumor resections, or congenital defects. 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 21230?

CPT 21230 is used to describe the surgical procedure in which the provider grafts autogenous rib cartilage from the patient’s own body to the face. This procedure is performed to repair deformities resulting from fractures, injuries, tumor resections, or congenital defects, such as saddle nose deformity.

2. Official Description

The official description of CPT code 21230 is: ‘Graft rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft).’ This code encompasses the entire process of harvesting the cartilage graft from the patient’s rib and grafting it to the desired area of the face.

3. Procedure

The procedure for CPT code 21230 involves several steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the rib area chosen for harvesting the cartilage graft.
3. Sufficient autograft material is removed from the rib.
4. The wound from the rib harvest is closed.
5. If repairing a saddle nose deformity, the provider carves the rib graft into two pieces: a dorsal graft and a columellar strut.
6. The dorsal graft and columellar strut are interdigitated or interlocked to recreate an intact L-shaped strut, restoring the normal shape of the nose.
7. The graft is positioned correctly, and the provider sutures the dome of the nose over the graft with a transdomal suture, closing the wound.

4. Qualifying circumstances

CPT 21230 is performed on patients who require the repair of deformities caused by fractures, injuries, tumor resections, or congenital defects. The procedure involves grafting autogenous rib cartilage, which is harvested from the patient’s own body. It is important to note that in many cases, this procedure may be performed for cosmetic purposes, and most insurers do not reimburse it. However, if the procedure is medically necessary and not solely for cosmetic reasons, obtaining preauthorization from the insurer is recommended.

5. When to use CPT code 21230

CPT code 21230 should be used when the provider performs the autogenous rib cartilage grafting procedure to repair deformities of the face, chin, nose, or ear. It is important to ensure that the procedure is medically necessary and not solely for cosmetic purposes, as reimbursement may be affected.

6. Documentation requirements

To support a claim for CPT 21230, the provider must document the following information:

• Patient’s diagnosis and the medical necessity of the procedure
• Details of the procedure, including the specific area of the face, chin, nose, or ear where the graft was applied
• Description of the grafting technique used
• Date of the procedure
• Any additional relevant information, such as the size of the graft or any complications encountered
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 21230, it is important to ensure that the procedure meets the criteria outlined in the code description. The provider should report this code only if the grafting procedure is performed and the autogenous rib cartilage is used. It is also crucial to verify the medical necessity of the procedure and obtain any required preauthorization from the insurer. Additionally, it is important to note that CPT code 21230 should not be reported with other codes that describe similar procedures.

8. Historical information

CPT code 21230 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

Here are some examples of cases where CPT code 21230 may be billed:

1. A patient with a saddle nose deformity due to a previous injury undergoes autogenous rib cartilage grafting to restore the normal shape of the nose.
2. A patient with a congenital defect in the ear undergoes autogenous rib cartilage grafting to reconstruct the ear.
3. A patient with a facial deformity resulting from a tumor resection undergoes autogenous rib cartilage grafting to repair the defect.
4. A patient with a chin deformity due to a fracture undergoes autogenous rib cartilage grafting to restore the normal appearance of the chin.
5. A patient with a nasal deformity resulting from a previous surgery undergoes autogenous rib cartilage grafting to correct the defect.