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Advice needed

louise Posted Wed 27th of November, 2019 06:50:02 AM
DX: 1. left mandibular condylar neck fracture - S02.652A 2. right symphysis mandibular fracture - S02.69XA Procedures: 1. Closed reduction with arch bar of bilateral condylar mandibular fracture - CPT code 21453 2. ORIF of symphysis mandibular fracture - CPT code 21462 The doctor wants to use both codes for the surgery. But from my research, it looks like I can use the CPT code 21470, that will include both fractures. 21470 - open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation Or should I do 21461 and 21461, 59 - one for each side (LT angle fracture and RT parasymphysis fracture)
SuperCoder Answered Thu 28th of November, 2019 06:37:19 AM

Hi Louise,

Thank you for your question.

The appropriate ICD-10 codes for left mandibular condylar neck fracture is S02.652A and for symphysis mandibular fracture will be S02.66XA.

CPT code for arch bar of bilateral condylar mandibular fracture will be 21453-with modifier 50 and CPT 21462 for ORIF of symphysis mandibular fracture with modifier 59.

Rationale:

Since a fracture of the mandible can occur at different sites, your clinician might have to treat each of these fractures using different methods. When your surgeon treats two different fractures sites using different surgical approaches, you will have to pay heed to Correct Coding Initiative (CCI) edits, as many of these codes that you use for different surgical treatments for reduction of mandibular fractures are bundled.

Feel free to ask for any further query.

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