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The procedure described by CPT® Code 21249 involves the complete reconstruction of the mandible or maxilla using an endosteal implant, which can be in the form of a blade or cylinder. This surgical intervention is typically indicated for patients who have lost teeth and require structural support for dental prosthetics. The physician performs the reconstruction by making an incision in the area of the jaw where teeth are absent, allowing for direct access to the underlying bone. The bone is meticulously exposed to facilitate the insertion of the implant. Pre-drilled precision holes are created in the bone to ensure accurate placement of the implant. Once the implant is positioned, the surrounding tissue is carefully arranged and sutured around the implant post, ensuring stability and proper healing. In the case of blade-style implants, the tissue is sutured around the implant, while cylindrical implants require the tissue to be closed over the top of the posts. It is important to note that a subsequent surgical procedure will be necessary to attach the dental prosthesis to the implants, completing the restoration of function and aesthetics for the patient. All incisions made during the procedure are ultimately closed to promote healing and recovery.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure coded as CPT® 21249 is indicated for patients who require complete reconstruction of the mandible or maxilla due to the absence of teeth. This may be necessary in cases where there is significant bone loss or structural compromise in the jaw, which can occur due to various conditions such as trauma, congenital defects, or severe periodontal disease. The use of endosteal implants is essential for providing a stable foundation for future dental prosthetics, allowing for improved function and aesthetics.
The procedure begins with the physician making an incision over the area of the jaw where teeth are absent. This incision allows for direct access to the underlying bone, which is then carefully exposed to the greatest extent possible. Once the bone is adequately exposed, the physician prepares the site for the endosteal implant by creating pre-drilled precision holes in the bone. These holes are crucial for ensuring the accurate placement of the implant, which can be either blade or cylinder type. After the implant is inserted into the pre-drilled holes, the surrounding tissue is meticulously arranged and sutured around the implant post. In the case of blade-style implants, the tissue is sutured directly around the implant, while for cylindrical implants, the tissue is closed over the top of the posts. This step is vital for securing the implant in place and promoting proper healing. Following the placement of the implant, all incisions made during the procedure are closed to facilitate recovery. It is important to note that a subsequent surgical procedure will be required to attach the dental prosthesis to the implants, completing the reconstruction process.
After the completion of the procedure, patients can expect a recovery period during which the surgical site will heal. It is essential for patients to follow post-operative care instructions provided by their physician to minimize the risk of complications. This may include guidelines on pain management, oral hygiene, and dietary restrictions. Patients should be aware that a follow-up surgical procedure will be necessary to attach the dental prosthesis to the implants once the healing process is complete. Regular follow-up appointments will be crucial to monitor the healing progress and ensure the success of the implant integration into the jawbone.
| Short Descr | RECONSTRUCTION OF JAW | Medium Descr | RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE | Long Descr | Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete | 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) | 0 - Payment restriction for assistants at surgery applies 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 | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 2 | 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. | 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). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | GA | Waiver of liability statement issued as required by payer policy, individual case | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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