How To Use CPT Code 21245

CPT code 21245 describes the reconstruction of a portion of the maxilla or mandible, also known as the upper or lower jaw, using a subperiosteal implant. 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 21245?

CPT 21245 is used to describe the reconstruction of a portion of the maxilla or mandible using a subperiosteal implant. This procedure is performed to repair defects that inhibit the function of the jaw. The provider applies a metal plate to the top of the jaw bone to restore its structure and functionality.

2. Official Description

The official description of CPT code 21245 is: ‘Reconstruction of mandible or maxilla, subperiosteal implant partial.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider makes an incision in the oral mucosa along the oblique line of the ramus to expose the jaw bone.
3. A two-holed trocar is used to place posterior pins percutaneously through the skin.
4. A second pair of pins is placed anteriorly, compressing the skin between the two pin sites to reduce tension on the wound.
5. The subperiosteal implant is attached to the pins.
6. The provider closes the wound in layers using absorbable sutures.

4. Qualifying circumstances

CPT 21245 is performed when there is a need to reconstruct a portion of the maxilla or mandible using a subperiosteal implant. This procedure is typically done to repair defects that affect the function of the jaw. It is important to note that some insurers may consider this procedure as cosmetic, so preauthorization is recommended to ensure coverage for medically necessary reasons.

5. When to use CPT code 21245

CPT code 21245 should be used when a provider performs a reconstruction of a portion of the maxilla or mandible using a subperiosteal implant. This code is specific to partial reconstructions and should not be used for complete reconstructions or other types of jaw surgeries.

6. Documentation requirements

To support a claim for CPT 21245, the provider must document the following information:

• Patient’s diagnosis and the need for jaw reconstruction
• Details of the procedure, including the use of a subperiosteal implant
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures or services performed during the same session
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 21245, ensure that the procedure meets the criteria for reconstruction of a portion of the maxilla or mandible using a subperiosteal implant. It is important to note that some insurers may consider this procedure as cosmetic, so preauthorization is recommended to ensure coverage for medically necessary reasons. Report CPT code 21245 separately and do not report it with other codes unless additional procedures or services were performed during the same session.

8. Historical information

CPT code 21245 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient with a defect in the maxilla undergoes a reconstruction procedure using a subperiosteal implant.
2. A provider performs a partial reconstruction of the mandible using a subperiosteal implant to repair a defect that affects the patient’s ability to chew and speak.
3. A patient with a congenital jaw deformity undergoes a reconstruction procedure using a subperiosteal implant to improve jaw function and aesthetics.
4. A provider performs a partial reconstruction of the maxilla using a subperiosteal implant to repair a defect caused by trauma.
5. A patient with a tumor in the mandible undergoes a reconstruction procedure using a subperiosteal implant after tumor removal.
6. A provider performs a partial reconstruction of the maxilla using a subperiosteal implant to correct a jaw defect caused by a previous surgery.
7. A patient with a degenerative jaw condition undergoes a reconstruction procedure using a subperiosteal implant to restore jaw function.
8. A provider performs a partial reconstruction of the mandible using a subperiosteal implant to repair a defect caused by a dental infection.
9. A patient with a jaw defect resulting from a developmental disorder undergoes a reconstruction procedure using a subperiosteal implant to improve jaw function and appearance.
10. A provider performs a partial reconstruction of the maxilla using a subperiosteal implant to repair a defect caused by a congenital abnormality.