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The procedure described by CPT® Code 21193 involves the reconstruction of the mandibular rami, which are the vertical portions of the lower jawbone. This reconstruction is achieved through various osteotomy techniques, specifically horizontal, vertical, C, or L osteotomies. These surgical methods are employed to correct deformities of the mandible, which may arise from congenital issues, trauma, or other pathological conditions. The procedure is performed under general anesthesia to ensure the patient is completely unconscious and free from pain during the operation. The surgeon makes incisions in the mandible, which may include an intraoral approach, allowing access to the bone without external scarring. Once the mandibular rami are exposed, specialized instruments such as osteotomes, saws, and burs are utilized to create precise cuts in the bone. This manipulation allows the surgeon to separate the mandible into distinct parts, which can then be repositioned to achieve the desired anatomical configuration. Fixation of the newly positioned bone segments is accomplished using plates, screws, and wires, ensuring stability during the healing process. In cases where a bone graft is not required, the procedure is coded as 21193. However, if a bone graft is necessary, which involves harvesting bone from the patient's hip, rib, or skull to augment the surgical site, the procedure would be coded as 21194. The use of an antibiotic solution is standard practice to minimize the risk of infection, and the incisions are subsequently closed. Additionally, intermaxillary fixation may be employed to stabilize the jaw during the recovery phase.
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The procedure described by CPT® Code 21193 is indicated for the correction of various mandibular deformities. These deformities may result from a range of conditions, including:
The procedure for reconstructing the mandibular rami involves several critical steps, which are detailed as follows:
After the reconstruction of the mandibular rami, patients can expect a recovery period that may involve some swelling, discomfort, and limited mobility of the jaw. Post-operative care typically includes pain management, monitoring for signs of infection, and adherence to dietary restrictions to facilitate healing. Follow-up appointments are essential to assess the healing process and ensure that the mandible is properly aligned. If intermaxillary fixation was utilized, patients may need to follow specific instructions regarding jaw movement and diet until the fixation is removed. Overall, the recovery process is crucial for achieving optimal functional and aesthetic outcomes following the procedure.
| Short Descr | RECONST LWR JAW W/O GRAFT | Medium Descr | RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF | Long Descr | Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; 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) | 2 - 150% payment adjustment 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). | 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). | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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 |
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| 1991-01-01 | Added | First appearance in code book in 1991. |
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