Otolaryngology Coding Alert

Question: The otolaryngologist performed open treatment of an orbital floor blowout fracture using a periorbital approach with alloplastic implant. Two separate incisions (inferior and medial) were made. Two bony holes were plugged, one via each incision. Should we report 21390 twice?

Connecticut Subscriber

Answer: The number of incisions and/or implants is irrelevant when 21390 (Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant) is used to report a periorbital approach. Therefore, you should report 21390 only once.

If the procedure took a significant amount of additional time and/or effort, document the extra effort and append modifier -22 (Unusual procedural services). Keep in mind, however, that most carriers are unlikely to pay more for two incisions or implants even with modifier -22 appended.