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The CPT® Code 21256 refers to the surgical procedure known as reconstruction of the orbit, which involves the use of osteotomies and bone grafts. This procedure is typically performed to address conditions such as micro-ophthalmia, where the eye socket (orbit) may be underdeveloped or malformed. During the surgery, the physician may harvest bone grafts from the patient's own body, commonly from areas such as the hip, rib, or skull. The choice of graft site depends on the specific needs of the reconstruction and the availability of suitable bone. Access to the orbit can be achieved through various incision points, including the lower eyelid, eyebrow, or maxillary vestibule, allowing the surgeon to reach the orbital area effectively. Once access is obtained, specialized instruments such as drills and saws are utilized to create precise incisions in the orbital rims. The repositioning of the bone is a critical step, as it ensures that the orbit is shaped correctly to support the eye and its functions. The repositioned bone is then secured in place using wires, screws, and plates, which provide stability during the healing process. Finally, the harvested grafts are placed into the designated recipient beds within the orbit, and all incisions are meticulously closed to promote optimal healing and minimize scarring.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 21256 is indicated for various conditions that necessitate the reconstruction of the orbit. These indications may include:
The procedure for CPT® Code 21256 involves several critical steps to ensure successful reconstruction of the orbit. These steps include:
After the completion of the orbital reconstruction procedure, patients can expect a recovery period that may involve monitoring for complications such as infection or bleeding. Post-operative care typically includes pain management, instructions for activity restrictions, and follow-up appointments to assess healing. Patients may also be advised on how to care for the surgical site to ensure proper recovery. The expected recovery time can vary based on the extent of the surgery and the individual patient's healing process. It is important for patients to adhere to their physician's post-operative instructions to achieve the best possible outcomes.
| Short Descr | RECONSTRUCTION OF ORBIT | Medium Descr | RECONSTRUCTION ORBIT W/OSTEOTOMIES & BONE GRAFTS | Long Descr | Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (eg, micro-ophthalmia) | 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) | 1 - 150% payment adjustment for bilateral procedures applies. | 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 |
| 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). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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) |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 1991-01-01 | Added | First appearance in code book in 1991. |
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