How To Use CPT Code 21267

CPT code 21267 describes a surgical procedure known as orbital repositioning. 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 21267?

CPT 21267 is a code used to describe the surgical procedure of orbital repositioning. This procedure is performed by a healthcare provider to treat facial deformities resulting from trauma or congenital conditions. It involves repositioning one side of the orbit, which is the bony cavity that holds the eyes, without entering the skull. Bone grafts may also be applied during the procedure to fill in any spaces that remain after the repositioning.

2. Official Description

The official description of CPT code 21267 is: ‘Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts extracranial approach.’

3. Procedure

During the orbital repositioning procedure, the healthcare provider makes bicoronal and maxillary vestibular incisions to access the orbit. Using a microsaw, the provider then makes cuts in the bony surface of the orbit on one side. The bones are realigned into a predetermined position and secured in place with wires. If necessary, bone grafts are shaped and applied to fill in any remaining spaces. The provider irrigates the area, checks for bleeding, removes any instruments, and closes the incision.

4. Qualifying circumstances

Patients who may require orbital repositioning are those with facial deformities resulting from trauma or congenital conditions. The procedure is performed on one side of the orbit, making it a unilateral procedure. It is important to note that the procedure is performed using an extracranial approach, meaning it does not involve entering the skull.

5. When to use CPT code 21267

CPT code 21267 should be used when a healthcare provider performs orbital repositioning on one side of the orbit using an extracranial approach. It is important to append the appropriate modifier (LT for left side or RT for right side) when reporting the code for a unilateral procedure. Modifier 50, which indicates a bilateral procedure, should not be used for this code.

6. Documentation requirements

To support a claim for CPT code 21267, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for orbital repositioning
• Details of the procedure, including the specific incisions made and the use of bone grafts
• Date of the procedure
• Any complications or unexpected findings
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 21267, ensure that the procedure meets the criteria for orbital repositioning on one side of the orbit using an extracranial approach. Append the appropriate modifier (LT or RT) to indicate the side on which the procedure was performed. It is important to note that modifier 50 should not be used for this code, as it is not applicable to bilateral procedures.

8. Historical information

CPT code 21267 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 21267

There are several similar codes to CPT 21267 that describe other repair, revision, and/or reconstruction procedures on the head. Some examples include:

• CPT 21120: Reconstruction of orbital floor fracture
• CPT 21125: Reconstruction of orbital roof fracture
• CPT 21210: Reconstruction of orbital walls, extracranial approach
• CPT 21235: Reconstruction of orbital walls, intracranial approach
• CPT 21240: Reconstruction of orbital rims, extracranial approach

9. Examples

1. A patient with a facial deformity resulting from trauma undergoes orbital repositioning on the left side to correct the alignment of the orbit.
2. A child with a congenital condition undergoes orbital repositioning on the right side to improve the symmetry of the eyes and facial features.
3. A patient with a history of facial trauma undergoes orbital repositioning on the left side, along with bone grafts, to restore the normal appearance of the orbit.
4. An adult with a congenital condition undergoes orbital repositioning on the right side to correct the positioning of the eye and improve vision.
5. A patient with a facial deformity resulting from trauma undergoes orbital repositioning on the left side, along with bone grafts, to restore the structural integrity of the orbit.
6. An elderly patient with a congenital condition undergoes orbital repositioning on the right side to improve the overall facial symmetry and appearance.
7. A teenager with a history of facial trauma undergoes orbital repositioning on the left side to correct the alignment of the orbit and improve vision.
8. A patient with a congenital condition undergoes orbital repositioning on the right side to enhance the aesthetic appearance of the eyes and facial features.
9. An adult with a facial deformity resulting from trauma undergoes orbital repositioning on the left side to restore the normal position of the eye and improve functionality.
10. A child with a congenital condition undergoes orbital repositioning on the right side to correct the alignment of the orbit and improve overall facial symmetry.