How To Use CPT Code 21406

CPT 21406 describes the open treatment of a fracture of the orbit, except for blowout fractures without an implant. 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 21406?

CPT 21406 is used to describe the open treatment of a fracture of the orbit, excluding blowout fractures without the use of an implant. This code is used when a healthcare provider performs a surgical procedure to treat a fracture of the bony structure that holds the eyes, resulting from blunt force trauma.

2. Official Description

The official description of CPT code 21406 is: ‘Open treatment of fracture of orbit, except blowout without implant.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The healthcare provider makes a periorbital incision over the area of the fracture.
3. The provider dissects through the tissue to visualize the fractured orbit.
4. Using surgical tools, the provider reduces, or realigns, the fractured bones back into normal positioning.
5. The area is irrigated, checked for bleeding, and any instruments are removed.
6. The provider then closes the incision.

4. Qualifying circumstances

CPT 21406 is used for the treatment of fractures of the orbit, excluding blowout fractures. It is important to note that blowout fractures involve the force of trauma blowing out the walls of the orbit. The procedure is performed by a healthcare provider and does not involve the use of an implant.

5. When to use CPT code 21406

CPT code 21406 should be used when a healthcare provider performs an open treatment procedure for a fracture of the orbit, excluding blowout fractures, without the use of an implant. It is important to accurately document the specific details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 21406, the healthcare provider must document the following information:

• Patient’s diagnosis of a fracture of the orbit
• Details of the open treatment procedure performed
• Specific location and extent of the fracture
• Incision site and approach used
• Any reduction or realignment of fractured bones
• Confirmation of irrigation, absence of bleeding, and removal of instruments
• Closure of the incision

7. Billing guidelines

When billing for CPT 21406, ensure that the procedure meets the criteria for an open treatment of a fracture of the orbit, excluding blowout fractures, without the use of an implant. It is important to accurately document the details of the procedure to support the billing of this code. Additionally, follow any specific billing guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 21406 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 sustains a fracture of the orbit due to blunt force trauma. The healthcare provider performs an open treatment procedure, excluding blowout fractures, without the use of an implant.
2. Following a car accident, a patient presents with a fracture of the orbit. The healthcare provider performs an open treatment procedure, excluding blowout fractures, without the use of an implant.
3. A patient is involved in a physical altercation and suffers a fracture of the orbit. The healthcare provider performs an open treatment procedure, excluding blowout fractures, without the use of an implant.
4. During a sporting event, a player is hit in the face and sustains a fracture of the orbit. The healthcare provider performs an open treatment procedure, excluding blowout fractures, without the use of an implant.
5. A patient falls and hits their face, resulting in a fracture of the orbit. The healthcare provider performs an open treatment procedure, excluding blowout fractures, without the use of an implant.
6. Following a workplace accident, a patient presents with a fracture of the orbit. The healthcare provider performs an open treatment procedure, excluding blowout fractures, without the use of an implant.
7. An elderly patient trips and falls, resulting in a fracture of the orbit. The healthcare provider performs an open treatment procedure, excluding blowout fractures, without the use of an implant.
8. A patient is involved in a physical assault and sustains a fracture of the orbit. The healthcare provider performs an open treatment procedure, excluding blowout fractures, without the use of an implant.
9. During a recreational activity, a patient is struck in the face and suffers a fracture of the orbit. The healthcare provider performs an open treatment procedure, excluding blowout fractures, without the use of an implant.
10. A patient is involved in a motor vehicle accident and presents with a fracture of the orbit. The healthcare provider performs an open treatment procedure, excluding blowout fractures, without the use of an implant.