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A Le Fort III fracture, commonly referred to as craniofacial separation or dysjunction, represents a significant and complex 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 moving through the lateral orbital wall, the zygomaticofrontal junction, and the zygomatic arch. Additionally, a branch of the fracture extends through the base of the perpendicular plate of the ethmoid and the vomer, as well as the interface of the pterygoid plates leading to the base of the sphenoid. The procedure denoted by CPT® Code 21433 involves the open treatment of a complicated Le Fort III fracture, which may be classified as complicated due to characteristics such as comminution or involvement of cranial nerve foramina. The surgical intervention necessitates multiple surgical approaches to adequately address the complexity of the fracture. Surgical exposure may be achieved through various incisions, including sublabial incisions for maxillary access, subciliary or transconjunctival incisions for orbital rim access, and columellar-septal transfixion incisions for access to the piriform aperture and front maxillary region. In cases where further exposure is required, additional incisions may be made in the lateral brow glabellar fold or a bicoronal scalp flap may be utilized. The procedure aims to reduce the fracture and verify anatomic reduction through radiographic means, followed by stabilization using interdental fixation.
© Copyright 2025 Coding Ahead. All rights reserved.
The open treatment of craniofacial separation (LeFort III type) is indicated for patients presenting with complex midface fractures that exhibit specific characteristics. These indications include:
The procedure for the open treatment of a complicated Le Fort III fracture involves several critical steps to ensure proper reduction and stabilization of the fracture. These steps include:
Post-procedure care for patients who have undergone open treatment of a complicated Le Fort III fracture includes monitoring for complications such as infection, neurological deficits, and proper healing of the fracture. Patients may require follow-up imaging to assess the stability of the fracture and the effectiveness of the reduction. Pain management and instructions for activity restrictions are also essential components of post-operative care to ensure optimal recovery.
| Short Descr | OPTX CRANFCL SEP COMP MLT | Medium Descr | OPEN TX CRANIOFACIAL SEP COMPLICATED MLT APPR | Long Descr | Open treatment of craniofacial separation (LeFort III type); complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approaches | 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) | 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 | 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 |
| 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). | 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). | 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. | 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 | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2025-01-01 | Changed | Short Description changed. |
| Pre-1990 | Added | Code added. |
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