Otolaryngology Coding Alert

Question: An otolaryngologist documents "closed reduction of nasal bone fracture." Should I use closed or open codes?

Ohio Subscriber

Answer: Don't confuse the fracture type (ICD-9) with the treatment type (CPT). The type of fracture, such as open, compound, or percutaneous, does not have any coding correlation with the type of treatment, closed or open.

Action: Look at whether your otolaryngologist opens the fracture site. If she doesn-t, you should use a closed treatment code (21310-21320). When she surgically opens the fractured bone or opens the bone remotely from the fracture site, you should assign an open repair code (21325-21330).

Your case involves a closed treatment, which the surgeon indicates with "closed reduction." CPT contains three closed treatment codes:

- 21310 (Closed treatment of nasal bone fracture without manipulation) is for closed treatment of the nasal bone without manipulation (reduction)

- 21315 (Closed treatment of nasal bone fracture; without stabilization) describes fracture reduction without stabilization

- 21320 (... with stabilization) represents fracture reduction with stabilization, such as with a nose splint.

Solution: In your case, report 21315 for the closed reduction or manipulation without a nose splint. Link this to the type of nasal bone fracture. When the physician does not indicate closed or open, as in your case, ICD-9 fracture guidelines instruct you to classify the fracture as closed. Therefore, you should use 802.0 (Nasal bones, closed), instead of 802.1 (Nasal bones, open).