How To Use CPT Code 21470

CPT code 21470 describes the open treatment of a complicated mandibular fracture using multiple surgical approaches, including internal fixation, interdental fixation, and/or wiring of dentures or splints. 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 21470?

CPT code 21470 is used to describe the open treatment of a complicated mandibular fracture. This procedure involves repairing damage to the lower jaw bone caused by blunt force trauma to the face. The provider accesses the fracture through multiple incisions and applies a fixation device to secure the fracture while it heals.

2. Official Description

The official description of CPT code 21470 is: ‘Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints.’

3. Procedure

During the procedure for CPT code 21470, the provider begins by appropriately prepping and anesthetizing the patient. Incisions are made in front of the ear and along the jawbone. The provider then dissects down to the fractured bones and reduces, or realigns, the mandibular fracture. Wires and screws are placed along the upper and lower arches to stabilize the fracture. Metal wires are attached around the teeth and secured to arch bars for fixation. The provider irrigates the area, checks for bleeding, removes any instruments, and closes the incisions.

4. Qualifying circumstances

CPT code 21470 is used for the treatment of a complicated mandibular fracture. This code is appropriate when the fracture requires multiple surgical approaches, such as internal fixation, interdental fixation, and/or wiring of dentures or splints. The provider must access the fracture through multiple incisions and use these techniques to repair and stabilize the fracture.

5. When to use CPT code 21470

CPT code 21470 should be used when the provider performs open treatment for a complicated mandibular fracture using multiple surgical approaches. This code is not appropriate for less complicated fractures or when only one surgical approach is used. It is important to accurately document the complexity of the fracture and the specific surgical approaches used to support the use of CPT code 21470.

6. Documentation requirements

To support a claim for CPT code 21470, the provider must document the following information:

• Patient’s diagnosis of a complicated mandibular fracture
• Details of the surgical approaches used, such as internal fixation, interdental fixation, and/or wiring of dentures or splints
• Description of the incisions made and the reduction of the fracture
• Documentation of the fixation devices used, including wires and screws
• Confirmation of irrigation, hemostasis, and closure of the incisions

7. Billing guidelines

When billing for CPT code 21470, ensure that the procedure meets the criteria for a complicated mandibular fracture and the use of multiple surgical approaches. It is important to accurately document the complexity of the fracture and the specific surgical techniques used. Modifier 52, Reduced services, may be appended to the second code if the provider treats two complicated sites but only wires the patient’s jaw shut once. If reporting more than one code for less complicated fractures, such as in the case of an angle fracture and a condyle fracture, append modifier 51, Multiple procedures, to the second code instead.

8. Historical information

CPT code 21470 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 21470

There are several similar codes to CPT code 21470 that may be used depending on the specific circumstances of the mandibular fracture. These codes include:

• CPT 21465: Open treatment of mandibular fracture without interdental fixation
• CPT 21461: Open treatment of mandibular fracture
• CPT 21462: Open treatment of mandibular fracture with interdental fixation
• CPT 21466: Closed treatment of mandibular fracture; without manipulation
• CPT 21467: Closed treatment of mandibular fracture; with manipulation

9. Examples

1. A patient sustains a complicated mandibular fracture due to a car accident. The provider performs open treatment using multiple surgical approaches, including internal fixation and wiring of dentures, to repair and stabilize the fracture.
2. A patient presents with a complicated mandibular fracture resulting from a sports injury. The provider accesses the fracture through multiple incisions and applies interdental fixation to secure the fracture during the healing process.
3. A patient suffers a complicated mandibular fracture due to a fall. The provider performs open treatment using multiple surgical approaches, including internal fixation and interdental fixation, to realign and stabilize the fracture.
4. A patient experiences a complicated mandibular fracture as a result of an assault. The provider accesses the fracture through multiple incisions and applies wiring of dentures and splints to ensure proper healing and alignment.
5. A patient sustains a complicated mandibular fracture during a sporting event. The provider performs open treatment using multiple surgical approaches, including internal fixation and interdental fixation, to repair and stabilize the fracture.
6. A patient presents with a complicated mandibular fracture caused by a workplace accident. The provider accesses the fracture through multiple incisions and applies wiring of dentures and splints to secure the fracture during the healing process.
7. A patient suffers a complicated mandibular fracture due to a fall from a bicycle. The provider performs open treatment using multiple surgical approaches, including internal fixation and interdental fixation, to realign and stabilize the fracture.
8. A patient experiences a complicated mandibular fracture as a result of a physical altercation. The provider accesses the fracture through multiple incisions and applies wiring of dentures and splints to ensure proper healing and alignment.
9. A patient sustains a complicated mandibular fracture during a recreational activity. The provider performs open treatment using multiple surgical approaches, including internal fixation and interdental fixation, to repair and stabilize the fracture.