How To Use CPT Code 21347

CPT 21347 describes the open treatment of a nasomaxillary complex fracture, specifically a LeFort II type fracture, which requires multiple open 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 21347?

CPT 21347 is used to describe the open treatment of a nasomaxillary complex fracture, specifically a LeFort II type fracture. This type of fracture typically occurs due to blunt force trauma and involves the bones in the nose and the upper jaw (maxilla). The procedure requires multiple open approaches to repair and stabilize the fractured segments.

2. Official Description

The official description of CPT code 21347 is: ‘Open treatment of nasomaxillary complex fracture (LeFort II type) requiring multiple open approaches.’

3. Procedure

The procedure for CPT 21347 involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision, which can be sublabial, subciliary, transconjunctival, and/or columellar septal transfixion type, to expose the maxillary bone.
3. The provider then reduces, or realigns, the fractured segments.
4. The pyramidal-shaped free maxillary segment is stabilized to the zygoma (cheekbone).
5. A fixation plate may be placed in the zygomaticomaxillary buttress and screwed into position. Alternatively, steel wiring may be used to secure the reduced fracture to the dental ridge.
6. The area is irrigated, checked for bleeding, and any instruments are removed.
7. The incision is closed.

4. Qualifying circumstances

CPT 21347 is performed for patients with a nasomaxillary complex fracture, specifically a LeFort II type fracture. This type of fracture involves the maxilla and the bones in the nose. The procedure requires multiple open approaches to repair and stabilize the fractured segments.

5. When to use CPT code 21347

CPT code 21347 should be used when performing the open treatment of a nasomaxillary complex fracture, specifically a LeFort II type fracture, that requires multiple open approaches. It is important to accurately document the specific fracture type and the need for multiple open approaches to support the use of this code.

6. Documentation requirements

To support a claim for CPT 21347, the following documentation is required:

• Patient’s diagnosis of a nasomaxillary complex fracture, specifically a LeFort II type fracture
• Description of the multiple open approaches used during the procedure
• Date of the procedure
• Details of the reduction and stabilization of the fractured segments
• Any fixation plates or steel wiring used
• Confirmation of irrigation, absence of bleeding, and removal of instruments
• Description of the closure of the incision

7. Billing guidelines

When billing for CPT 21347, ensure that the procedure performed meets the requirements for an open treatment of a nasomaxillary complex fracture, specifically a LeFort II type fracture, requiring multiple open approaches. It is important to accurately document the details of the procedure and provide the necessary supporting documentation.

8. Historical information

CPT 21347 was added to the Current Procedural Terminology system on January 1, 1990. It has undergone changes in its status as an Inpatient Only (IPO) procedure for Medicare reimbursement. It was initially added to the IPO list, then removed, and subsequently added and removed again in different years.

9. Similar codes to CPT 21347

There are several similar codes to CPT 21347 that involve the treatment of fractures and dislocations on the head. Some examples include:

• CPT 21315: Open treatment of nasal bone fracture
• CPT 21320: Open treatment of nasal bone fracture with manipulation
• CPT 21325: Closed treatment of nasal bone fracture without manipulation
• CPT 21335: Open treatment of nasal bone fracture with internal fixation
• CPT 21497: Open treatment of zygomatic fracture, including orbital floor, arch, and/or zygomatic complex fracture

9. Examples

Here are some examples of cases where CPT code 21347 may be used:

1. A patient sustains a LeFort II type fracture due to a car accident. The provider performs an open treatment using multiple approaches to repair and stabilize the fractured segments.
2. An individual experiences a severe injury to the face during a sports activity, resulting in a nasomaxillary complex fracture. The provider performs an open treatment with multiple approaches to realign and stabilize the fractured bones.
3. A patient suffers a LeFort II type fracture as a result of a fall. The provider performs an open treatment using various approaches to reduce and stabilize the fractured segments.
4. An individual sustains a nasomaxillary complex fracture during an assault. The provider performs an open treatment with multiple approaches to repair and stabilize the fractured bones.
5. A patient undergoes an open treatment for a LeFort II type fracture caused by a workplace accident. The provider utilizes multiple approaches to realign and stabilize the fractured segments.