CPT® Code 21431

Official Description

Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splint

Common Language Description

A Le Fort III fracture, commonly referred to as craniofacial separation or dysjunction, represents a significant injury characterized by a transverse fracture of the midface. This type of fracture initiates at the nasofrontal and frontomaxillary sutures, extending posteriorly along the medial wall of the orbit, traversing through the nasolacrimal groove and the ethmoid bones. The fracture path continues along the floor of the orbit at the inferior orbital fissure, subsequently affecting the lateral orbital wall, zygomaticofrontal junction, and zygomatic arch. Additionally, a branch of the fracture may extend through the base of the perpendicular plate of the ethmoid and vomer, as well as the interface of the pterygoid plates leading to the base of the sphenoid. The procedure described by CPT® Code 21431 involves a closed treatment approach, where disimpaction of the maxillary bone is achieved through the use of disimpaction forceps or other instruments that are inserted either intranasally or intraorally. Following the disimpaction, anatomic reduction of the fracture is confirmed through radiographic imaging, and stabilization is accomplished using arch bars that are affixed to the upper and lower molars, along with interdental wire fixation. This method is distinct from the open reduction technique outlined in CPT® Code 21432, which involves surgical incisions and the use of miniplates and screws for stabilization.

1. Indications

The closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation is indicated for patients presenting with specific types of midfacial fractures. These indications include:

Le Fort III Fracture A transverse fracture of the midface that involves the nasofrontal and frontomaxillary sutures, extending through various anatomical structures of the face.
Craniofacial Separation A condition where the midface is separated from the cranial base, often resulting from significant trauma.
Facial Trauma Patients who have sustained facial injuries that compromise the structural integrity of the midface and require stabilization.

2. Procedure

The procedure for closed treatment of a Le Fort III fracture involves several critical steps to ensure proper alignment and stabilization of the fractured bones. The first step is the disimpaction of the maxillary bone, which is achieved using specialized instruments such as disimpaction forceps. These instruments are inserted either intranasally or intraorally to facilitate the separation of the fractured segments. Once disimpaction is successfully performed, the next step is to verify anatomic reduction of the fracture. This is accomplished through radiographic imaging, which allows the surgeon to confirm that the bones are properly aligned. Following confirmation of the reduction, the fracture is stabilized using arch bars. These bars are securely placed on the upper and lower molars, providing a framework for stabilization. Finally, interdental wire fixation is applied to further secure the arch bars in place, ensuring that the fractured segments remain in the correct position during the healing process.

3. Post-Procedure

After the closed treatment procedure, patients are typically monitored for any signs of complications, such as infection or misalignment of the fracture. Post-procedure care may include pain management and instructions for oral hygiene to prevent infection at the surgical sites. Patients are advised to follow up with their healthcare provider for radiographic evaluations to ensure proper healing and alignment of the facial structures. The expected recovery period may vary depending on the severity of the fracture and the individual patient's healing response, but close monitoring is essential to achieve optimal outcomes.

Short Descr	CLTX CRANIOFACIAL SEPARATION
Medium Descr	CLOSED TX CRANIOFACIAL SEPARATION
Long Descr	Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splint
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)	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	Inpatient Procedures, not paid under OPPS
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