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The procedure described by CPT® Code 21147 involves the reconstruction of the midface using a LeFort I osteotomy technique, which is particularly relevant for patients with significant facial bone deformities or for cosmetic enhancements. This complex surgical intervention is characterized by the movement of three or more segments of the maxilla, the upper jawbone, in any direction. The procedure necessitates the use of bone grafts, which may include obtaining autografts from the patient’s own body, such as the iliac crest. The LeFort I osteotomy specifically targets the lower maxillary region, situated below the infraorbital nerve and medial to the zygomatic-maxillary suture, allowing for substantial repositioning of the midface. The surgical approach includes careful planning and execution to ensure minimal trauma to surrounding tissues, with specific techniques employed to facilitate the movement of bone segments and the integration of grafts. This procedure is essential for addressing conditions such as ungrafted bilateral alveolar clefts or cases requiring multiple osteotomies, ultimately aiming to restore functional and aesthetic balance to the facial structure.
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The LeFort I reconstruction procedure, as described by CPT® Code 21147, is indicated for various conditions and circumstances that necessitate significant alterations to the midface structure. These include:
The procedure for LeFort I reconstruction involves several detailed steps to ensure successful midface reconstruction. The following outlines the procedural steps:
After the completion of the LeFort I reconstruction procedure, patients typically require careful monitoring and follow-up care. Post-procedure care may include pain management, instructions for oral hygiene, and dietary modifications to accommodate healing. Patients are advised to avoid strenuous activities and follow specific guidelines to ensure proper recovery. Follow-up appointments are essential to assess the healing process, check the stability of the bone grafts, and ensure that the maxilla remains in the desired position. Any complications or concerns should be addressed promptly to facilitate optimal recovery.
| Short Descr | LEFORT I-3/> PIECE W/ GRAFT | Medium Descr | RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS | Long Descr | Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies) | 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 | Inpatient Procedures, not paid under OPPS | 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 |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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 |
| 1991-01-01 | Added | First appearance in code book in 1991. |
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