Oral Surgery Coding & Reimbursement Alert

Question: I am new to surgery coding. When reporting treatment of fractures, for example, a LeFort I or a mandibular fracture, how do I select a code as I see there are many different codes to report for each type of fracture?

Michigan Subscriber

Answer: When reporting a fracture such as a Lefort type I or a mandibular fracture, you will have to base your code choice on the type of reduction that your surgeon employed. The types of reduction that your surgeon might opt for include:

• Closed reduction wherein your surgeon will not directly visualize the fractured bones
• Open reduction where your surgeon will have direct sight of the fractured bones
• Percutaneous reduction wherein your surgeon will make a small puncture wound to approach the fracture site.

The next thing that you will have to focus on to help arrive at the right choice of code is to see whether or not your surgeon placed any fixation to help stabilize the reduced fractured fragments. So, you will have different choices based on type of fixation that your clinician used. Some of the choices that you will have to opt from include:

• Use of no fixation after the reduction
• Use of external fixation
• Use of internal fixation
• Use of interdental fixation or wiring of dentures or splints.

So, for instance, if your surgeon performed a closed treatment of a LeFort I type of fracture with the use of interdental wire fixation, you will have to choose 21421 (Closed treatment of palatal or maxillary fracture [LeFort I type], with interdental wire fixation or fixation of denture or splint) for the procedure. For open reduction of a LeFort I fracture, you will have to report 21422 (Open treatment of palatal or maxillary fracture [LeFort I type]).

For an open reduction of a mandibular fracture without any fixation, you will have to choose to report 21461 (Open treatment of mandibular fracture; without interdental fixation). When your surgeon performs the same reduction with interdental fixation, you will have to choose to report 21462 (…with interdental fixation).  

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