How To Use CPT Code 21268

CPT 21268 describes a surgical procedure known as orbital repositioning, periorbital osteotomies, unilateral, with bone grafts combined intra- and extracranial approach. 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 21268?

CPT 21268 is a specific code used to describe a surgical procedure called orbital repositioning, periorbital osteotomies, unilateral, with bone grafts combined intra- and extracranial approach. This procedure is performed to treat facial deformities resulting from trauma or congenital conditions. It involves the repositioning of the eye socket on one side and the use of bone grafts to fill in any defects.

2. Official Description

The official description of CPT code 21268 is: ‘Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts combined intra- and extracranial approach.’

3. Procedure

The procedure for CPT code 21268 involves several steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the site chosen for harvesting a bone graft, typically the hip bone.
3. Sufficient autograft material is removed from the patient’s own body, or alternatively, donor bone graft may be used.
4. Bicoronal and maxillary vestibular incisions are made.
5. A frontal craniotomy is performed to access the orbit from inside the patient’s cranium.
6. The provider uses a microsaw to cut into the orbits, nasal bones, and ethmoid bone.
7. The bones are realigned into the correct anatomical position and secured with wires.
8. Bone graft material is shaped and used to fill in any remaining spaces.
9. The grafts are secured in place with wires or screws.
10. The area is irrigated, checked for bleeding, and the remaining incisions are closed in layers.

4. Qualifying circumstances

CPT 21268 is performed on patients with facial deformities resulting from trauma or congenital conditions. It is a unilateral procedure, meaning it is performed on one side of the face. The use of bone grafts is necessary to fill in any defects. The procedure requires the expertise of a qualified healthcare professional.

5. When to use CPT code 21268

CPT code 21268 should be used when performing orbital repositioning, periorbital osteotomies, unilateral, with bone grafts combined intra- and extracranial approach. 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 21268, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for orbital repositioning
• Details of the procedure performed, including the specific incisions made and the use of bone grafts
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional procedures performed
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 21268, ensure that the procedure meets the specific criteria outlined in the code description. It is important to follow the guidelines provided by the payer and to use the appropriate modifiers if necessary. Check with individual payers to determine their specific policies and requirements for reporting CPT code 21268.

8. Historical information

CPT code 21268 was added to the Current Procedural Terminology system on January 1, 1990. It has undergone changes in terms of its inclusion in the Inpatient Only (IPO) list for Medicare. It was initially added to the IPO list in 2017, removed in 2021, and added back in 2022.

9. Similar codes to CPT 21268

There are several similar codes to CPT 21268 that describe other repair, revision, and/or reconstruction procedures on the head. These codes include:

• CPT 21120: Reconstruction midface, Le Fort I
• CPT 21121: Reconstruction midface, Le Fort II
• CPT 21122: Reconstruction midface, Le Fort III
• CPT 21123: Reconstruction midface, Le Fort I and II
• CPT 21125: Reconstruction midface, Le Fort II and III

9. Examples

1. A patient with a facial deformity resulting from trauma undergoes orbital repositioning, periorbital osteotomies, unilateral, with bone grafts combined intra- and extracranial approach to correct the deformity.
2. A patient with a congenital condition affecting the eye socket undergoes orbital repositioning, periorbital osteotomies, unilateral, with bone grafts combined intra- and extracranial approach to improve the appearance and function of the affected area.
3. A healthcare professional performs orbital repositioning, periorbital osteotomies, unilateral, with bone grafts combined intra- and extracranial approach on a patient who has experienced facial trauma resulting in a facial deformity.
4. A patient with a congenital condition affecting the eye socket undergoes orbital repositioning, periorbital osteotomies, unilateral, with bone grafts combined intra- and extracranial approach to correct the position of the eye socket and improve overall facial symmetry.
5. A healthcare professional performs orbital repositioning, periorbital osteotomies, unilateral, with bone grafts combined intra- and extracranial approach on a patient with a facial deformity resulting from trauma, restoring the natural position of the eye socket and improving facial aesthetics.
6. A patient with a congenital condition affecting the eye socket undergoes orbital repositioning, periorbital osteotomies, unilateral, with bone grafts combined intra- and extracranial approach to correct the deformity and improve the function of the affected area.