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Official Description

Open treatment of fracture of orbit, except blowout; without implant

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 21406 refers to the open treatment of a fracture of the orbit, specifically excluding blowout fractures, and is performed without the use of an implant. This procedure is designed to restore the natural shape of the orbit, which is the bony cavity that houses the eye. In cases of orbital fractures, the integrity of the orbit can be compromised, leading to potential complications such as misalignment of the eye, double vision, or damage to surrounding structures. The open repair technique involves making an incision to access the fractured area directly, allowing for precise manipulation and correction of the fracture. The procedure may also include the use of a temporary tarsorrhaphy, which is a technique to protect the cornea by suturing the eyelids partially closed. This is particularly important during the initial stages of the procedure to prevent exposure and injury to the eye. The surgical approach requires careful dissection to preserve the surrounding tissues and nerves, ensuring that the repair is both effective and minimizes the risk of complications. Overall, the goal of this procedure is to restore the anatomical and functional integrity of the orbit, thereby improving the patient's visual and cosmetic outcomes.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The open treatment of an orbital fracture, as described by CPT® Code 21406, is indicated for specific conditions related to the integrity of the orbit. These indications include:

  • Non-blowout orbital fractures - These are fractures that do not involve the classic blowout pattern, which typically occurs when a force is applied to the eye, causing the orbital floor to fracture while the surrounding bone remains intact.
  • Displacement of orbital structures - When the fracture leads to misalignment or displacement of the eye or surrounding tissues, surgical intervention may be necessary to restore proper positioning.
  • Herniation of orbital soft tissue - In cases where soft tissue has herniated through a bony defect, surgical repair is required to reposition the tissue and restore the orbital anatomy.
  • Visual impairment or double vision - If the fracture results in visual disturbances or diplopia (double vision), surgical correction may be warranted to alleviate these symptoms.

2. Procedure

The procedure for the open treatment of an orbital fracture involves several detailed steps, which are as follows:

  • Step 1: Evaluation and Incision Marking - The natural skin creases around the eye are evaluated, and incision lines are carefully marked to ensure minimal scarring and optimal access to the fractured area.
  • Step 2: Temporary Tarsorrhaphy - A temporary tarsorrhaphy may be performed to protect the cornea. This involves placing a mattress suture through the edges of the upper and lower eyelids to partially close the lids over the eye, providing protection during the procedure.
  • Step 3: Skin Incision - The skin is incised along the marked lines to visualize the underlying orbicular muscle. This incision is extended subcutaneously over the pretarsal portion of the orbicularis oculi muscle to create a skin flap that spans the full length of the incision.
  • Step 4: Dissection Plane Creation - A dissection plane is created between the orbicularis oculi muscle and the septum orbitale. Suborbicular undermining of the muscle is performed using a slit-like lateral incision over the bony orbital rim, allowing access to the fracture site.
  • Step 5: Suborbicular Pocket Extension - The suborbicular dissection plane is opened while leaving the orbital septum intact. The suborbicular pocket is extended downward over the entire lower palpebral region, and the upper portion of the pocket below the tarsus is opened.
  • Step 6: Creation of Skin Muscle Flap - The remaining layer of the orbicularis oculi muscle is separated just below the lower border of the tarsus to create a skin muscle flap that is congruent with the lower eyelid.
  • Step 7: Retraction and Periosteal Stripping - The eyelid and flap are retracted inferiorly over the anterior edge of the infraorbital rim. A periosteal elevator is then employed to strip the periosteum from the bone, exposing the fracture site.
  • Step 8: Identification and Reduction of Fracture - The intraorbital nerve is identified and preserved during dissection along the upper facial surface of the anterior maxilla. The borders of the fracture are identified, and any orbital soft tissue that has herniated through the bony deficit is reduced back into place.
  • Step 9: Fracture Repair - If indicated, the fracture may be repaired with hardware to stabilize the bony structure. This step is crucial for ensuring proper healing and alignment of the orbit.
  • Step 10: Closure - The periosteum is redraped over the bony surface and secured, completing the surgical repair of the orbital fracture.

3. Post-Procedure

After the completion of the open treatment for an orbital fracture, specific post-procedure care is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or excessive swelling. Pain management may be provided as needed, and patients are advised to avoid activities that could strain the eye or the surgical site. Follow-up appointments are crucial to assess healing and ensure that the eye is functioning properly. Patients may also receive instructions regarding the care of the incision site to promote healing and minimize scarring. Overall, the recovery process will vary depending on the individual case and the extent of the fracture.

Short Descr OPN TX ORBIT FX W/O IMPLANT
Medium Descr OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT
Long Descr Open treatment of fracture of orbit, except blowout; without implant
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) 1 - 150% payment adjustment for bilateral procedures applies.
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
ASC Payment Indicator Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P3D - Major procedure, orthopedic - other
MUE 1
CCS Clinical Classification 144 - Treatment, facial fracture or dislocation
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
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).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AG Primary physician
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
ET Emergency services
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
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2013-01-01 Changed Short Descriptor changed.
Pre-1990 Added Code added.
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