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The procedure described by CPT® Code 21267 involves orbital repositioning through periorbital osteotomies, specifically performed on one side (unilateral) and utilizing bone grafts. This surgical intervention is conducted via an extracranial approach, meaning that the access to the orbit is achieved from outside the cranial cavity. The term "orbital repositioning" refers to the adjustment of the position of the eye socket (orbit) to correct deformities or misalignments that may affect vision or facial aesthetics. The use of periorbital osteotomies indicates that the surgeon makes precise cuts in the bone surrounding the orbit to facilitate this repositioning. Bone grafts are integral to this procedure, as they are used to fill in any voids or defects created during the repositioning process. These grafts can be harvested from various donor sites on the patient's body, including the hip, rib, or skull, ensuring that the graft material is biocompatible and conducive to healing. The surgical access points for this procedure can vary, with common incisions made through the lower eyelid, eyebrow, or maxillary vestibule, allowing the surgeon to reach the orbital area effectively. Once the orbit is accessed, specialized instruments such as drills and saws are employed to create the necessary incisions in the orbital rim. After repositioning the orbit, the surgeon secures it in place using various fixation devices, including wires, screws, and plates. Finally, the incisions made during the procedure are meticulously closed to promote optimal healing and minimize scarring.
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The procedure described by CPT® Code 21267 is indicated for various conditions that necessitate the repositioning of the orbit. These may include:
The procedure for orbital repositioning using CPT® Code 21267 involves several critical steps, each essential for achieving the desired outcome.
After the completion of the procedure, the patient is monitored in a recovery area to ensure stable vital signs and to manage any immediate postoperative discomfort. Instructions for care at home are provided, which may include guidelines on activity restrictions, pain management, and signs of potential complications to watch for. Follow-up appointments are typically scheduled to assess healing and the success of the orbital repositioning. Patients may experience swelling and bruising around the eyes, which is expected and should gradually resolve. The overall recovery time can vary based on individual circumstances and the extent of the procedure performed.
| Short Descr | REVISE EYE SOCKETS | Medium Descr | ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL | Long Descr | Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach | 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 | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | 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). | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | E2 | Lower left, eyelid | 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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| Pre-1990 | Added | Code added. |
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