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The CPT® Code 21407 refers to the open treatment of a fracture of the orbit, specifically excluding blowout fractures, and involves the use of an implant. This procedure is designed to restore the orbit, which is the bony cavity that houses the eye, to its natural anatomical shape and function. The process begins with a thorough evaluation of the natural skin creases around the eye, followed by the careful marking of incision lines to minimize scarring. A temporary tarsorrhaphy, which is a surgical procedure that partially closes the eyelids, may be performed to protect the cornea during the operation. This is achieved by placing a mattress suture through the edges of the upper and lower eyelids, allowing for the closure of the eyelids over the eye, thus providing additional protection. Once the eyelids are secured, an incision is made along the pre-marked lines to access the underlying orbicular muscle. The incision is extended subcutaneously to create a skin flap that allows for better visualization and access to the orbital area. The surgeon then creates a dissection plane between the orbicularis oculi muscle and the septum orbitale, which is the fibrous membrane that separates the orbit from the surrounding structures. This dissection is performed carefully to preserve the integrity of the orbital septum. The procedure continues with the extension of the suborbicular pocket, which is a space created for the surgical intervention, and involves careful manipulation of the muscle and surrounding tissues. The identification and preservation of the intraorbital nerve are critical steps to avoid complications. The surgeon then identifies the fracture borders and reduces any herniated orbital soft tissue, ensuring that the fracture is properly aligned. An orbital implant, which can be made from various materials such as porous polyethylene, silicone, Teflon, Supramid, titanium mesh, or bioresorbable copolymer plates, is inserted into the bony deficit. This implant serves to prevent the prolapse of orbital soft tissue and to restore the natural contour and volume of the orbit. Finally, the periosteum, which is the connective tissue covering the bone, is redraped over the implant and secured with sutures, completing the procedure.
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The open treatment of a fracture of the orbit, as described by CPT® Code 21407, is indicated for the following conditions:
The procedure for the open treatment of an orbital fracture involves several detailed steps:
Post-procedure care following the open treatment of an orbital fracture includes monitoring for any signs of complications, such as infection or improper healing. Patients may be advised to avoid strenuous activities and to follow specific instructions regarding eye care to ensure proper recovery. Follow-up appointments are essential to assess the healing process and the positioning of the implant. Pain management may also be necessary, and the use of cold compresses can help reduce swelling in the initial recovery phase. The surgeon will provide detailed instructions on when normal activities can be resumed and any additional care that may be required during the recovery period.
| Short Descr | OPN TX ORBIT FX W/IMPLANT | Medium Descr | OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT | Long Descr | Open treatment of fracture of orbit, except blowout; with 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). | 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. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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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