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A therapeutic temporomandibular joint (TMJ) manipulation is a specialized procedure aimed at addressing various disorders associated with the TMJ, which is the joint connecting the jawbone to the skull. This manipulation is performed under the influence of anesthesia, which can be either general anesthesia or monitored anesthesia care, ensuring that the patient remains comfortable and pain-free throughout the procedure. The primary goal of TMJ manipulation is to alleviate symptoms such as clicking and popping sounds in the joint, pain experienced in the jaw area, and restricted movement of the jaw. During the procedure, a local anesthetic is also administered directly to the temporomandibular joint, targeting the surrounding muscles, including the masseter, temporalis, medial pterygoid, and lateral pterygoid muscles, as necessary. This dual approach of using both general or monitored anesthesia and local anesthetic helps to ensure that the patient does not experience discomfort during the manipulation process. Once adequate local anesthesia is achieved, the clinician performs manual manipulation of the jaw. The initial step involves moving the mandible backward (posteriorly) and holding it in that position. Following this, the jaw is gradually manipulated downward (inferiorly) and then moved side-to-side. This series of movements is designed to open the joint space, thereby enhancing the range of motion of the jaw. The clinician evaluates the range of motion throughout the procedure and may repeat the manipulation as needed until the maximum range of motion is attained and any joint clicking is resolved. This comprehensive approach to TMJ manipulation aims to restore normal function and alleviate discomfort associated with TMJ disorders.
© Copyright 2025 Coding Ahead. All rights reserved.
The therapeutic manipulation of the temporomandibular joint (TMJ) is indicated for a variety of symptoms and conditions that affect the function and comfort of the jaw. These indications include:
The procedure for therapeutic manipulation of the temporomandibular joint involves several key steps that are performed in a controlled environment to ensure patient safety and comfort. The steps include:
After the therapeutic manipulation of the temporomandibular joint, patients may experience some degree of soreness or discomfort in the jaw area, which is typically manageable with prescribed pain relief methods. It is important for patients to follow any post-procedure care instructions provided by the clinician, which may include recommendations for rest, ice application, and gradual reintroduction of normal jaw movements. Patients should also be monitored for any signs of complications or persistent symptoms, and follow-up appointments may be scheduled to assess the effectiveness of the procedure and make any necessary adjustments to the treatment plan.
| Short Descr | MNPJ OF TMJ W/ANESTH | Medium Descr | MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA | Long Descr | Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 162 - Other OR therapeutic procedures on joints |
| 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2008-01-01 | Added | First appearance in code book in 2008. |
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