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The procedure described by CPT® Code 21194 involves the reconstruction of the mandibular rami, which are the vertical parts of the lower jawbone. This reconstruction is achieved through various types of osteotomies, specifically horizontal, vertical, C, or L-shaped cuts in the bone. The primary goal of this surgical intervention is 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, which may include an intraoral approach, to access the mandible effectively. Once the mandibular rami are exposed, specialized surgical instruments such as osteotomes, saws, and burs are utilized to create precise cuts in the bone. This allows the surgeon to separate the mandible into distinct parts, which can then be repositioned to achieve the desired anatomical alignment. To secure the newly formed structure, the surgeon employs fixation devices such as plates, screws, and wires. In cases where additional support is required, a bone graft may be harvested from the patient's own body, typically from the hip, rib, or skull, and placed at specific sites within the surgical area to promote healing and stability. The use of an antibiotic solution is standard practice to minimize the risk of infection, and the incisions are subsequently closed to complete the procedure. It is important to note that intermaxillary fixation may be necessary to maintain the position of the mandible during the initial healing phase. This code is specifically used when bone grafts are involved; if no graft is required, a different code (CPT® Code 21193) should be utilized.
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The procedure described by CPT® Code 21194 is indicated for various conditions that necessitate the reconstruction of the mandibular rami. These indications may include:
The procedure for CPT® Code 21194 involves several critical steps to ensure successful reconstruction of the mandibular rami. These steps include:
After the completion of the procedure, the patient is monitored in a recovery area until the effects of anesthesia wear off. Post-operative care may include pain management, instructions for oral hygiene, and dietary modifications to accommodate the healing process. The surgeon may recommend follow-up visits to assess healing and ensure that the mandible is properly aligned. Intermaxillary fixation may be employed to maintain the position of the mandible during the initial recovery phase. Patients are advised to avoid strenuous activities and follow specific guidelines provided by their healthcare team to promote optimal recovery.
| Short Descr | RECONST LWR JAW W/GRAFT | Medium Descr | RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT | Long Descr | Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining 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) | 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 | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | 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. | 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.) |
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| 1991-01-01 | Added | First appearance in code book in 1991. |
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