How To Use CPT Code 21407

CPT code 21407 describes the open treatment of a fracture of the orbit, excluding a blowout fracture, with the use of 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 21407?

CPT 21407 is used to describe the open 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. The procedure involves making an incision over the fracture, realigning the fractured bones, and stabilizing them with an implant.

2. Official Description

The official description of CPT code 21407 is: ‘Open treatment of fracture of orbit, except blowout, with implant.’

3. Procedure

The procedure for CPT code 21407 involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. An incision is made over the area of the fracture.
3. The provider dissects through the tissue to visualize the fractured orbit.
4. The fractured bones are reduced or realigned back into their normal positioning.
5. An implant of the appropriate size is applied to the fractured bones to stabilize them.
6. The implant is secured in place using screws or wires.
7. The area is irrigated, checked for bleeding, and any instruments are removed.
8. The incision is closed.

4. Qualifying circumstances

CPT code 21407 is used for fractures of the orbit that do not result in a blowout fracture. A blowout fracture occurs when the force of trauma blows out the walls of the orbit. The procedure is performed by a qualified healthcare professional and involves the use of an implant to stabilize the fractured bones.

5. When to use CPT code 21407

CPT code 21407 should be used when performing an open treatment of a fracture of the orbit, excluding a blowout fracture, with the use of an implant. It is important to ensure that the fracture meets the specific criteria for this code and that the procedure is performed as described in the official description.

6. Documentation requirements

To support a claim for CPT code 21407, the healthcare professional must document the following information:

• Patient’s diagnosis of a fracture of the orbit, excluding a blowout fracture
• Details of the procedure performed, including the use of an implant
• 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 code 21407, ensure that the procedure meets the specific criteria outlined in the official description. It is important to accurately document and code the procedure to ensure proper reimbursement. There are no specific guidelines regarding reporting CPT code 21407 with other codes.

8. Historical information

CPT code 21407 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 21407

There are several similar codes to CPT code 21407 that describe other procedures for fractures and dislocations on the head. Some examples include:

• CPT 21315: Treatment of nasal bone fracture
• CPT 21401: Treatment of fracture of malar area (zygomatic bone)
• CPT 21421: Treatment of fracture of mandibular body or angle
• CPT 21431: Treatment of fracture of maxillary sinus floor or lateral wall
• CPT 21452: Treatment of fracture of nasal septum

9. Examples

1. A patient sustains a fracture of the orbit due to blunt force trauma. The healthcare professional performs an open treatment of the fracture, excluding a blowout fracture, using an implant to stabilize the fractured bones.
2. Another patient presents with a fracture of the orbit resulting from a sports injury. The healthcare professional performs an open treatment of the fracture, excluding a blowout fracture, and utilizes an implant to stabilize the fractured bones.
3. A third patient experiences a fracture of the orbit following a car accident. The healthcare professional performs an open treatment of the fracture, excluding a blowout fracture, and employs an implant to stabilize the fractured bones.
4. Yet another patient suffers a fracture of the orbit due to a fall. The healthcare professional performs an open treatment of the fracture, excluding a blowout fracture, and utilizes an implant to stabilize the fractured bones.
5. A final patient sustains a fracture of the orbit during a physical altercation. The healthcare professional performs an open treatment of the fracture, excluding a blowout fracture, and employs an implant to stabilize the fractured bones.