louise Posted Fri 05th of April, 2019 07:45:36 AM
: bony union achieved at previous left angle fracture with no mobility and stable occlusion; loose Champy plate and screws with bony sequestrum crestally, removed and debrided, irrigated and closed primarily
cpt used are 20670 21025 20680
intraoral incision only, incorporating fistula to expose fracture site to confirm union.
incision extending from external oblique ridge to buccal of tooth#18, incorporating existing fistula. #9 periosteal was then used to dissect subperiosteally to expose both mini plates that were placed superiorly and laterally. Lingual flap was also raised to examine quality of bone/union over lingual side. On opening, gross mobility was noted over all existing champy plate that was placed superiorly. 4 screws and entire plate was subsequently removed. Granulation tissue with reactive bone was noted underneath infected plate. This was then curetted off with #9 periosteal elevator and bone file. Dental curette was also used to remove any soft tissue/granulation tissue grown within bony cavities from infection. Buccal/lingual cortex was subsequently examined, noted to be intact. Inferior mini plate noted to be intact. A football fissure bur was then used to smoothen out reactive bone/further debride infected portion of mandible until bleeding healthy bone remains. This was irrigated copiously
SuperCoder Answered Mon 08th of April, 2019 06:44:19 AM
CPT codes 20680 and 21025 look appropriate for removal of deep implant and excision of mandibular bone. However, it is not clear from the provided records if any superficial implant was removal as well from the site of surgery. If more than one deep implant has been removed, you should bill 2 or more units to the maximum of 3 units as per the number of implants removed.