How To Use CPT Code 21454

CPT code 21454 describes the open treatment of a mandibular fracture with external fixation. 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 21454?

CPT 21454 is used to describe the open treatment of a mandibular fracture with external fixation. This code is used when a provider repairs damage caused by blunt force trauma to the face by accessing the fracture through an incision and applying an external fixation device to secure the fracture in place while it heals.

2. Official Description

The official description of CPT code 21454 is: ‘Open treatment of mandibular fracture with external fixation.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the mandible and dissects through the fascia and down to the fracture site.
3. The provider reduces, or realigns, the fractured bones back into their proper positions.
4. Wires and/or screws are applied to the fractured bones to hold them in position.
5. An external splint is attached to the screws or wires to secure the fracture.
6. The provider irrigates the wound and closes the incision.

4. Qualifying circumstances

CPT 21454 is used for patients who have a mandibular fracture that requires open treatment with external fixation. This procedure is typically performed to repair damage caused by blunt force trauma to the face. The patient must be appropriately prepped and anesthetized, and the provider must access the fracture through an incision and apply an external fixation device to secure the fracture in place.

5. When to use CPT code 21454

CPT code 21454 should be used when a provider performs the open treatment of a mandibular fracture with external fixation. This code is appropriate when the fracture requires surgical intervention and the provider applies an external fixation device to stabilize the fracture during the healing process.

6. Documentation requirements

To support a claim for CPT 21454, the provider must document the following information:

• Patient’s diagnosis of a mandibular fracture
• Details of the procedure, including the incision, reduction of the fractured bones, application of wires and/or screws, and attachment of the external splint
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 21454, ensure that the procedure meets the criteria for open treatment of a mandibular fracture with external fixation. Use the appropriate CPT code based on the specific procedure performed. It is important to follow the guidelines provided by the payer and submit accurate documentation to support the claim.

8. Historical information

CPT 21454 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 mandibular fracture due to a car accident. The provider performs an open treatment of the fracture with external fixation.
2. A patient is involved in a physical altercation and suffers a mandibular fracture. The provider performs an open treatment of the fracture with external fixation.
3. A patient falls and fractures their mandible. The provider performs an open treatment of the fracture with external fixation.
4. A patient is injured during a sporting event and fractures their mandible. The provider performs an open treatment of the fracture with external fixation.
5. A patient is assaulted and sustains a mandibular fracture. The provider performs an open treatment of the fracture with external fixation.
6. A patient is involved in a workplace accident and fractures their mandible. The provider performs an open treatment of the fracture with external fixation.
7. A patient is injured in a recreational activity and fractures their mandible. The provider performs an open treatment of the fracture with external fixation.
8. A patient sustains a mandibular fracture due to a fall. The provider performs an open treatment of the fracture with external fixation.
9. A patient is involved in a physical altercation and suffers a mandibular fracture. The provider performs an open treatment of the fracture with external fixation.
10. A patient falls and fractures their mandible. The provider performs an open treatment of the fracture with external fixation.