How To Use CPT Code 21400

CPT code 21400 describes the closed treatment of a fracture of the orbit, excluding blowout fractures, without manipulation. 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 21400?

CPT 21400 is used to describe the closed treatment of a fracture of the orbit, which is the bony structure that holds the eyes. This code specifically applies to fractures that do not result in a blowout fracture and do not require manipulation. The provider assesses and treats the fracture without manipulating the bones.

2. Official Description

The official description of CPT code 21400 is: ‘Closed treatment of fracture of orbit, except blowout without manipulation.’

3. Procedure

The procedure for CPT 21400 involves the following steps:

1. The patient is appropriately prepped, and the area may be anesthetized if necessary.
2. The provider examines the patient, checking for adequate vision and eyelid movement.
3. The provider confirms that the patient is otherwise stable.
4. The provider may prescribe medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation.
5. The provider may recommend the use of ice or heat, depending on the specific circumstances.

4. Qualifying circumstances

CPT 21400 is applicable to patients who have a fracture of the orbit that does not result in a blowout fracture. A blowout fracture occurs when the force of trauma causes the walls of the orbit to be blown out. The procedure does not involve any manipulation of the bones. The patient’s condition must be stable, and the provider must assess the patient for adequate vision and eyelid movement.

5. When to use CPT code 21400

CPT code 21400 should be used when a patient has a fracture of the orbit that does not result in a blowout fracture and does not require manipulation. If the fracture is a blowout fracture or requires manipulation, a different CPT code should be used to accurately describe the procedure performed.

6. Documentation requirements

To support a claim for CPT 21400, the provider must document the following information:

• Patient’s diagnosis of a fracture of the orbit
• Confirmation that the fracture does not result in a blowout fracture
• Details of the closed treatment procedure performed
• Prescribed medications, such as NSAIDs, if applicable
• Recommendations for ice or heat therapy, if applicable

7. Billing guidelines

When billing for CPT 21400, ensure that the procedure performed meets the criteria described in the official description. It is important to accurately document the diagnosis and procedure performed to support the claim. CPT code 21400 should not be reported with other codes unless additional procedures were performed that are separately identifiable and distinct from the closed treatment of the orbit fracture.

8. Historical information

CPT code 21400 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 presents with a fracture of the orbit resulting from blunt force trauma. The provider performs closed treatment without manipulation, prescribing NSAIDs for pain relief.
2. A patient sustains a fracture of the orbit due to a sports injury. The provider assesses the fracture and determines that it does not require manipulation. Ice therapy is recommended to reduce swelling.
3. A patient is involved in a car accident and fractures the orbit. The provider performs closed treatment without manipulation and prescribes NSAIDs for pain management.
4. A patient presents with a fracture of the orbit resulting from a fall. The provider confirms that the fracture does not require manipulation and recommends heat therapy to alleviate discomfort.
5. A patient sustains a fracture of the orbit during a physical altercation. The provider performs closed treatment without manipulation and prescribes NSAIDs for pain relief.
6. A patient is involved in a workplace accident and fractures the orbit. The provider assesses the fracture and determines that it does not require manipulation. Ice therapy is recommended to reduce swelling.
7. A patient presents with a fracture of the orbit resulting from a sports injury. The provider performs closed treatment without manipulation and prescribes NSAIDs for pain management.
8. A patient sustains a fracture of the orbit due to a fall. The provider confirms that the fracture does not require manipulation and recommends heat therapy to alleviate discomfort.
9. A patient is involved in a car accident and fractures the orbit. The provider performs closed treatment without manipulation and prescribes NSAIDs for pain relief.
10. A patient presents with a fracture of the orbit resulting from a physical altercation. The provider assesses the fracture and determines that it does not require manipulation. Ice therapy is recommended to reduce swelling.