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The CPT® Code 21356 refers to the open treatment of a depressed zygomatic arch fracture, commonly utilizing the Gillies approach. A depressed zygomatic arch fracture occurs when the zygomatic arch, a bony structure that forms the prominence of the cheek, is pushed inward due to trauma. This type of fracture can lead to aesthetic concerns and functional impairments, such as difficulties with jaw movement or vision, depending on the severity and displacement of the fracture. The Gillies approach is a well-established surgical technique that involves making an incision in the temporal region, just above the hairline, allowing the surgeon access to the zygomatic arch. During the procedure, specialized instruments are inserted beneath the muscle fascia to carefully manipulate the fractured bone back into its correct anatomical position. Once the fracture is adequately reduced, the instruments are removed, and the incisions are meticulously closed to promote optimal healing and minimize scarring. This procedure is essential for restoring both the structural integrity and aesthetic appearance of the facial skeleton.
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The open treatment of a depressed zygomatic arch fracture is indicated in the following scenarios:
The procedure for the open treatment of a depressed zygomatic arch fracture involves several critical steps:
After the open treatment of a depressed zygomatic arch fracture, patients are typically monitored for any immediate complications. Post-procedure care may include pain management, instructions for activity restrictions, and follow-up appointments to assess healing. Patients are advised to avoid strenuous activities and to follow specific guidelines regarding diet and oral hygiene to facilitate recovery. Swelling and bruising in the facial area are common and may take time to resolve. The surgeon will provide detailed aftercare instructions to ensure optimal recovery and to monitor for any signs of infection or complications.
| Short Descr | OPN TX DPRSD ZYGOMATIC ARCH | Medium Descr | OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE | Long Descr | Open treatment of depressed zygomatic arch fracture (eg, Gillies approach) | Status Code | Active Code | Global Days | 010 - Minor Procedure | 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) | 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 | 1 | CCS Clinical Classification | 144 - Treatment, facial fracture or dislocation |
| 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. | 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 | 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) | SG | Ambulatory surgical center (asc) facility service |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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