Otolaryngology Coding Alert

Question: Does the code 21462 (open treatment of mandibular fracture; with interdental fixation) include the removal of the arch bars at a later date? Also, is the correct code for removal of arch bars 20670 or 20680?

Connie Gregory
Greenville, N.C.

Answer: Open reduction of a mandible fracture, with interdental fixation (21462) occurs when a physician repositions and stabilizes a fractured mandible. Incisions are created either intraorally through the mucosa or in the skin over the fracture area. After the tissue is dissected and the bone is exposed, the fracture is manipulated into position, and held with plates, wires or screws. Sutures are used to close the incision and intermaxillary fixation is applied. The removal of arch bars at a later date would not be billed separately, says Cindy McMahan, CPC, an otolaryngology coding and reimbursement specialist at SVA Consulting in Albany, Wis. Code 20670 (removal of implant; superficial, [e.g., buried wire, pin or rod] [separate procedure]) is a separate procedure, which means it should be billed only when it is the only procedure performed in that body area.

Additionally, 20670 and 20680 (removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]) would be billed bilaterally using modifier -50 (bilateral procedure) if done on both sides of the jaw.

Code 20670 is defined as a physician making a small incision over the implant site and locating the implant. The implant is removed by the physician by pulling or unscrewing it. Sutures or steri-strips are used for closure. In the case where a deep dissection is extended down to the implant below the muscle level, code 20680 would be billed. If the same physician (or physician group) who performed the 21462 also removes the arch bars at a later date, the removal would not be billed separately.

If a physician (or physician group), however, performs procedure 21462 and at a later date a physician from a different physician group removes the arch bars, the physician removing the arch bars should be able to bill 20670. It may be necessary to provide proof that this physician did not perform the initial surgery.