© Copyright 2025 American Medical Association. All rights reserved.
Genioplasty is a surgical procedure aimed at correcting the bony contour of the chin through a technique known as sliding osteotomy. This procedure is particularly beneficial for patients who have either a receding or protruding chin, as it allows for the repositioning of the chin to achieve a more balanced facial profile. The surgery begins with an incision made in the gingivolabial sulcus, which is the groove between the gums and the lip, providing access to the underlying bone structure. Once the incision is made, the periosteum, a dense layer of connective tissue that covers the bones, is exposed. A subperiosteal dissection is then performed, which involves carefully separating the periosteum from the bone laterally from the midline until the mental nerves, responsible for sensation in the chin and lower lip, are identified and preserved. The next step involves determining the placement of the bone cuts, which are critical for the success of the procedure. The mandible, or lower jawbone, is then cut on each side using a sagittal saw, allowing for the chin to be either advanced forward or retruded backward, depending on the specific needs of the patient. After the desired position of the chin is achieved, the bone is secured in place using either wires or a plate and screw device, ensuring stability during the healing process. Finally, the overlying soft tissues are meticulously closed in layers to promote optimal healing and aesthetic outcomes. This procedure is coded as 21121 for a single piece sliding osteotomy, which involves a single bone cut on each side of the mandible, distinguishing it from other related procedures that may require multiple cuts or additional techniques.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure of genioplasty via sliding osteotomy is indicated for patients presenting with specific conditions related to the bony contour of the chin. These indications include:
The genioplasty procedure using a sliding osteotomy involves several critical steps to ensure successful outcomes. The first step is the creation of an incision in the gingivolabial sulcus, which allows access to the mandible while minimizing visible scarring. Following the incision, the surgeon exposes the periosteum, which is essential for the subsequent dissection. A subperiosteal dissection is performed laterally from the midline, carefully identifying and preserving the mental nerves to avoid sensory complications. Once the dissection is complete, the surgeon determines the appropriate placement for the bone cuts. The mandible is then cut on each side using a sagittal saw, which is a specialized surgical saw designed for precision. This cutting allows for the chin to be repositioned either forward or backward, depending on the specific anatomical needs of the patient. After achieving the desired position, the bone segments are secured in place using wires or a plate and screw device, which provides stability during the healing process. Finally, the overlying soft tissues are closed in layers, ensuring that the surgical site is properly sealed and promoting optimal healing. This meticulous closure is crucial for minimizing complications and achieving the best aesthetic results.
Post-procedure care following a genioplasty via sliding osteotomy is essential for ensuring proper recovery and minimizing complications. Patients are typically monitored for any immediate postoperative issues, such as bleeding or infection. Pain management is an important aspect of post-operative care, and patients may be prescribed analgesics to manage discomfort. Patients are advised to follow a soft diet for a specified period to avoid placing undue stress on the surgical site. Swelling and bruising are common after the procedure, and patients may be instructed to apply ice packs to the area to reduce these symptoms. Follow-up appointments are crucial for monitoring the healing process and ensuring that the bone is stabilizing in the desired position. Overall, adherence to post-procedure instructions is vital for achieving optimal results and ensuring a smooth recovery process.
| Short Descr | GENIOP SLDG OSTEOT 1 | Medium Descr | GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE | Long Descr | Genioplasty; sliding osteotomy, single piece | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply 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 | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 161 - Other OR therapeutic procedures on bone |
| 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). | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2025-01-01 | Changed | Short Description changed. |
| 1991-01-01 | Added | First appearance in code book in 1991. |
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