Marla Posted Fri 21st of December, 2012 20:24:08 PM
'Does CPT code 21335 include internal fixation? My physician dictates open reduction nasal fracture (did not do internal fixation) with septoplasty and am trying to figure out how to code this.'
SuperCoder Answered Fri 21st of December, 2012 20:46:33 PM
If procedure 21335 (open treatment of nasal fracture; with concomitant open treatment of fractured septum) is coded, the operative report should not say that the physician performed an open reduction of a nasal fracture and a septoplasty, but rather a septal repair or septal reduction because the reference to septoplasty will raise eyebrows when it is reviewed or audited.
The documentation also should include the correct diagnosis codes for the procedure in question. Associated ICD-9 codes vary among the different procedures, but all include the following:
470deviated nasal septum
802.0nasal bones, closed fracture
802.1nasal bones, open fracture
21335-Physicians perform open nasal fracture treatment when they are unable to reduce a patient's fracture externally. The surgery requires an incision into the nose to visualize the nasal and septal fractures and repair them.
The physician makes an incision over the fracture and into the cartilage to visualize the bone. He exposes the bone segments, and, using surgical tools, moves the fracture bone, cartilage, and/or bone fragments back into the appropriate positions. He then elevates any bone fragments into position and inserts fine wires to keep the bones in position, often using a minidrill to create holes in the bone to anchor the wires. The physician reduces the fractured septum into place, typically placing sutures into the septum to hold it in position. The physician closes the incision in layers.
There is no associated fracture of septum. Hence 21325 along with 30520 will be coded. But
Code 21325 is a column 2 code for 30520, These codes cannot be billed together in any circumstances.
Code 21325 is bundled into code 30520 Code 21325 cannot be billed with 30520.
Hence in the above case only septoplasty 30520 will be coded.