CPT® Code 21182

Official Description

Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting less than 40 sq cm

Common Language Description

The procedure described by CPT® Code 21182 involves the surgical reconstruction of the orbital walls, rims, forehead, and nasoethmoid complex following the excision of benign tumors from the cranial bone, such as fibrous dysplasia. This complex surgical intervention is performed under general anesthesia and requires the physician to create various incisions, which may include those in the eyelid and scalp, to access the affected areas. The excision of the tumors is carried out using both intra- and extracranial approaches, ensuring complete removal of the tumor tissue. Following the excision, the bones in the affected areas are carefully fractured and repositioned to restore their proper anatomical alignment. To facilitate this reconstruction, multiple autografts are harvested from the patient's own body, typically from the hip, rib, or skull. These grafts are then inserted into the surgical site to augment and stabilize the areas where the tumors have been removed. The use of fixation devices, such as wires, plates, and screws, is essential to maintain the structural integrity and shape of the facial bones during the healing process. The incisions made during the procedure are meticulously closed in layers to promote optimal healing and minimize scarring. It is important to note that this code is applicable when the total area of bone grafting is less than 40 square centimeters, distinguishing it from other related codes that apply to larger grafting areas.

1. Indications

The procedure described by CPT® Code 21182 is indicated for the reconstruction of the orbital walls, rims, forehead, and nasoethmoid complex following the excision of benign tumors of the cranial bone. The specific conditions that may warrant this surgical intervention include:

Benign Tumors of Cranial Bone The presence of benign tumors, such as fibrous dysplasia, necessitating surgical removal and subsequent reconstruction of the affected cranial structures.
Structural Defects Any structural defects in the orbital or facial regions resulting from tumor excision that require reconstruction to restore normal anatomy and function.
Facial Trauma Cases where facial trauma has occurred, leading to the need for reconstruction of the orbital and facial structures.

2. Procedure

The procedure for CPT® Code 21182 involves several critical steps to ensure successful reconstruction of the affected areas. These steps include:

Step 1: Anesthesia Administration The patient is placed under general anesthesia to ensure comfort and immobility during the surgical procedure.
Step 2: Incision Creation The surgeon creates various incisions, which may include eyelid and scalp incisions, to gain access to the surgical site where the tumors are located.
Step 3: Tumor Excision The benign tumors are excised using both intra- and extracranial approaches, ensuring complete removal of the tumor tissue while preserving surrounding structures as much as possible.
Step 4: Bone Fracturing and Repositioning The affected bones are carefully fractured and repositioned to restore their proper anatomical alignment, which is crucial for the overall function and appearance of the facial structure.
Step 5: Graft Harvesting Multiple autografts are harvested from the patient's own body, typically from the hip, rib, or skull, to be used in the reconstruction process.
Step 6: Graft Insertion The harvested bone grafts are inserted into the surgical site to augment and stabilize the areas where the tumors have been removed, ensuring proper support for the facial structures.
Step 7: Fixation Fixation devices, such as wires, plates, and screws, are utilized to maintain the proper shape and alignment of the facial bones during the healing process.
Step 8: Incision Closure Finally, the incisions are closed in layers to promote optimal healing and minimize scarring, ensuring a better cosmetic outcome for the patient.

3. Post-Procedure

After the completion of the procedure, patients can expect a recovery period that may involve monitoring for any complications, such as infection or bleeding. Post-operative care typically includes pain management, instructions for wound care, and follow-up appointments to assess healing and the success of the reconstruction. Patients may also be advised to avoid strenuous activities and to follow specific guidelines to ensure proper recovery. The expected recovery time can vary based on individual circumstances, but close adherence to post-operative instructions is essential for optimal outcomes.

Short Descr	RECONSTRUCT CRANIAL BONE
Medium Descr	RCNSTJ ORBIT/FHD/NASETHMD EXCBONE TUM GRF<40SQCM
Long Descr	Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting less than 40 sq cm
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	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).
AS	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC	This service has been performed in part by a resident under the direction of a teaching physician