Need help choosing the right code?
Ask CasePilot about procedures, modifiers, bundling, and coding guidance.
Try CasePilot© Copyright 2026 American Medical Association. All rights reserved.
The procedure described by CPT® Code 21142 involves the reconstruction of the midface using a LeFort I osteotomy technique, which is specifically designed for patients with congenital facial bone deformities or for cosmetic enhancements. This surgical intervention is characterized by the movement of two segments of the maxilla, which is the upper jawbone, without the use of bone grafts. The LeFort I osteotomy focuses on the lower maxillary region, which is anatomically defined as the area below the infraorbital nerve and medial to the zygomatic-maxillary suture. The procedure is initiated with the extraction of premolars and last molars as necessary to facilitate access to the surgical site. To minimize trauma to the palatal tissues during the osteotomy, the palatal mucosa is carefully tunneled. A buccal incision is made in the sulcus, extending from the first molar on one side to the first molar on the opposite side, allowing for exposure of the lateral aspect of the nasal cavity. The nasal mucosa is then elevated to provide a clear view of the underlying structures. Precise measurements taken prior to the surgery guide the physician in marking the planned bone cuts in the maxilla. The lateral wall of the maxilla is then cut using a bur, and a thin osteotome is employed to apply gentle pressure, facilitating the fracture of the medial and posterior walls of the maxilla. The procedure continues with the separation of the pterygoid plate from the maxilla using a pterygoid osteotome, followed by careful dissection of the pterygoid hamulus. This meticulous approach is mirrored on the opposite side of the maxilla. The nasal septum cartilage and vomer are also separated from the maxilla using a septal gouge or osteotome, ensuring that the anterior nasal spine is fractured appropriately. The maxilla is then downfractured and mobilized, allowing for repositioning and stabilization with wires. Throughout the procedure, the physician checks measurements to confirm the desired repositioning of the maxilla, as well as the alignment of the lip position and occlusion. An intermaxillary fixation device is applied to maintain the new position of the maxilla, and the buccal incision is subsequently closed. This comprehensive approach ensures that the midface is reconstructed effectively, addressing both functional and aesthetic concerns.
© Copyright 2026 Coding Ahead. All rights reserved.
The LeFort I osteotomy procedure described by CPT® Code 21142 is indicated for the following conditions:
The procedure involves several detailed steps to ensure successful midface reconstruction:
After the completion of the LeFort I osteotomy, patients are typically monitored for any immediate complications. Post-procedure care may include pain management, instructions for oral hygiene, and dietary modifications to accommodate healing. Patients are advised to follow up with their healthcare provider to assess the healing process and ensure that the maxilla remains in the desired position. The use of intermaxillary fixation devices may be continued for a specified period to maintain stability. Recovery time can vary, and patients should be informed about potential swelling and discomfort as part of the healing process.
| Short Descr | LEFORT I-2 PIECE W/O GRAFT | Medium Descr | RCNSTJ MIDFACE LEFORT I 2 PIECES W/O BONE GRAFT | Long Descr | Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 161 - Other OR therapeutic procedures on bone |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2013-01-01 | Changed | Short Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Changed | Code description changed |
| 1996-01-01 | Added | First appearance in code book in 1996. |
Get instant expert-level medical coding assistance.