How To Use CPT Code 21344

CPT 21344 describes the open treatment of a complicated frontal sinus fracture, typically performed through coronal or multiple approaches. 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 21344?

CPT 21344 is used to describe the open treatment of a complicated frontal sinus fracture. This procedure involves repairing the bones of the frontal sinus, located below the ridge of the brow, through one or more incisions in the corona or crown of the head. It is typically performed to address damage caused by blunt force trauma or crush injuries.

2. Official Description

The official description of CPT code 21344 is: ‘Open treatment of complicated (e.g., comminuted or involving posterior wall) frontal sinus fracture, via coronal or multiple approaches.’

3. Procedure

When performing CPT 21344, the healthcare provider begins by preparing and anesthetizing the patient. Bicoronal incisions are made across the scalp on the crown of the head to expose the frontal sinus. The provider then assesses whether there is an injury to the nasofrontal duct, which is the opening that drains the frontal sinus into the nasal cavity. The anterior table, or front portion of the sinus, is repaired using cancellous bone grafts harvested from the calvaria. The provider realigns the fracture and repairs any nasofrontal duct injury if present. If a dural tear is found, it is repaired. In cases involving a fracture of the posterior wall, the provider may cranialize the sinus, allowing the brain and dura to rest against the frontal wall of the sinus. The incision is closed in layers, and the patient is monitored for any bleeding or complications.

4. Qualifying circumstances

CPT 21344 is used for patients with complicated frontal sinus fractures, which may be comminuted or involve the posterior wall. These fractures are typically caused by blunt force trauma or crush injuries. The procedure is performed to repair the damage and restore the normal function of the frontal sinus. It is important to note that this code is specific to the treatment of frontal sinus fractures and should not be used for other types of fractures or injuries.

5. When to use CPT code 21344

CPT code 21344 should be used when a healthcare provider performs open treatment for a complicated frontal sinus fracture. This code is appropriate when the fracture involves comminuted bones or the posterior wall of the frontal sinus. It is important to accurately document the details of the fracture and the procedure performed to support the use of this code.

6. Documentation requirements

When reporting CPT code 21344, the healthcare provider must document the following information:

• Details of the frontal sinus fracture, including whether it is comminuted or involves the posterior wall
• Description of the procedure performed, including the approach used (coronal or multiple)
• Documentation of any additional repairs or grafts performed
• Any complications or unexpected findings during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 21344, it is important to ensure that the procedure meets the criteria for a complicated frontal sinus fracture. The use of this code should be supported by the documentation of the fracture and the procedure performed. It is also important to follow any specific billing guidelines provided by insurance carriers or payers. Additionally, it is important to be aware of any changes or updates to the billing guidelines for CPT code 21344.

8. Historical information

CPT code 21344 was added to the Current Procedural Terminology system on January 1, 1993. Since its addition, there have been several changes to its status as an inpatient-only (IPO) procedure. It was initially added to the IPO list, then removed, and later added back to the IPO list in 2022. It is important to stay updated on any changes to the status of this code to ensure accurate billing and reimbursement.

9. Similar codes to CPT 21344

There are several similar codes to CPT 21344 that may be used to describe related procedures. These include:

• CPT 21315: Open treatment of frontal sinus fracture, simple or without involvement of the posterior wall
• CPT 21320: Open treatment of frontal sinus fracture with obliteration, including repair of nasofrontal duct
• CPT 21325: Open treatment of frontal sinus fracture with obliteration, including repair of nasofrontal duct and cranialization or repair of posterior wall
• CPT 21335: Open treatment of frontal sinus fracture with obliteration, including repair of nasofrontal duct and cranialization or repair of posterior wall; with obliteration of frontal sinus
• CPT 21336: Open treatment of frontal sinus fracture with obliteration, including repair of nasofrontal duct and cranialization or repair of posterior wall; with obliteration of frontal sinus and repair of dural tear

9. Examples

1. A patient sustains a complicated frontal sinus fracture due to a motor vehicle accident. The healthcare provider performs open treatment using a coronal approach, repairing the fracture and addressing any associated injuries.
2. An individual experiences a crush injury to the forehead, resulting in a comminuted frontal sinus fracture. The healthcare provider performs open treatment through multiple approaches, reconstructing the fractured bones and restoring normal function.
3. A patient presents with a complicated frontal sinus fracture involving the posterior wall. The healthcare provider performs open treatment, cranializing the sinus and repairing any associated injuries.
4. An individual sustains a frontal sinus fracture during a sports-related incident. The healthcare provider performs open treatment using a coronal approach, repairing the fracture and ensuring proper alignment of the bones.
5. A patient suffers a complicated frontal sinus fracture as a result of a fall. The healthcare provider performs open treatment through multiple approaches, reconstructing the fractured bones and addressing any additional injuries.
6. An individual sustains a comminuted frontal sinus fracture due to a workplace accident. The healthcare provider performs open treatment using a coronal approach, repairing the fracture and assessing for any associated injuries.