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The procedure described by CPT® Code 21143 involves the reconstruction of the midface using a LeFort I osteotomy technique, which is performed without the use of bone grafts. This surgical intervention is typically indicated for patients presenting with congenital facial bone deformities or for cosmetic enhancements. The LeFort I osteotomy specifically targets the lower maxillary region, which is anatomically defined as the area below the infraorbital nerve and medial to the zygomatic-maxillary suture. During the procedure, the surgeon may extract premolars and last molars as necessary to facilitate access and manipulation of the maxilla. To minimize trauma to the palatal tissues, the palatal mucosa is carefully tunneled prior to making the osteotomy cuts. The surgical approach includes an incision in the buccal sulcus that extends from the first molar on one side to the first molar on the opposite side, allowing for exposure of the lateral aspect of the nasal cavity and elevation of the nasal mucosa. The surgeon then marks the planned bone cuts in the maxilla based on preoperative measurements, ensuring precision in the reconstruction process. This complex procedure allows for the movement of three or more bone segments in any direction, thereby enabling significant adjustments to the midface structure for functional and aesthetic purposes.
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The LeFort I osteotomy procedure, as described by CPT® Code 21143, is indicated for the following conditions:
The surgical procedure begins with the extraction of premolars and last molars as needed to facilitate access to the maxilla. The palatal mucosa is then carefully tunneled to prevent tearing of the palatal tissues during the maxillary osteotomy. An incision is made in the buccal sulcus, extending from the first molar on one side to the first molar on the opposite side, which allows for adequate exposure of the surgical site. The lateral aspect of the nasal cavity is exposed, and the nasal mucosa is elevated to provide a clear view of the underlying structures. The surgeon marks the planned bone cuts in the maxilla using preoperative measurements to ensure accuracy. Next, the lateral wall on one side of the maxilla is cut using a bur, and a thin osteotome is placed in the cut. Gentle pressure is applied to fracture the medial and posterior wall of the maxilla. The pterygoid plate is then separated from the maxilla using a pterygoid osteotome, and the pterygoid hamulus is located and carefully separated from the pterygoid plate. This process is repeated on the opposite side of the maxilla to ensure symmetry in the reconstruction. Following this, the nasal septum cartilage and vomer are separated from the maxilla using a septal gouge or osteotome. After fracturing the anterior nasal spine, the gouge or osteotome is angled towards the floor of the nose to facilitate further separation. The maxilla is then downfractured using thumb pressure and mobilized with the pterygoid osteotome. Once the maxilla is completely detached and mobile, an anterior osteotomy is performed at the premolar region bilaterally. The nasal septal cartilage, posterior wall, and palatal bone are trimmed to achieve the desired contour. After the necessary adjustments, the maxilla is repositioned and stabilized with wires. The surgeon checks measurements to confirm that the maxilla has been repositioned correctly, ensuring that lip position and occlusion are also satisfactory. An intermaxillary fixation device is applied to maintain the new position of the maxilla, and the buccal incision is subsequently closed to complete the procedure.
Post-procedure care following a LeFort I osteotomy includes monitoring the patient for any complications and ensuring proper healing of the surgical site. Patients may experience swelling and discomfort, which can be managed with prescribed pain medications. Follow-up appointments are essential to assess the healing process and the stability of the maxilla in its new position. The intermaxillary fixation device may remain in place for a specified duration to maintain alignment. Patients are advised on dietary modifications, typically starting with a soft diet to avoid strain on the surgical site. Oral hygiene is crucial during recovery to prevent infection, and patients should be instructed on proper care techniques. Overall, the recovery period will vary based on individual healing responses and adherence to post-operative guidelines.
| Short Descr | LEFORT I-3/> PIECE W/O GRAFT | Medium Descr | RCNSTJ MIDFACE LEFORT I 3/> PIECE W/O BONE GRAFT | Long Descr | Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft | 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) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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 | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2013-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Changed | Code description changed |
| 1996-01-01 | Added | First appearance in code book in 1996. |
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