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The CPT® Code 21435 refers to the open treatment of a craniofacial separation, specifically a LeFort III type fracture, which is classified as complicated. This type of fracture involves a significant disruption of the midface, characterized by a transverse fracture that begins at the nasofrontal and frontomaxillary sutures. The fracture extends posteriorly along the medial wall of the orbit, traversing through the nasolacrimal groove and the ethmoid bones. It continues along the floor of the orbit at the inferior orbital fissure and through the lateral orbital wall, zygomaticofrontal junction, and zygomatic arch. Additionally, 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 to the base of the sphenoid. Complicated fractures, as defined in this context, are those that are comminuted or involve the cranial nerve foramina, necessitating a more intricate surgical approach. The surgical exposure for this procedure may involve various incisions, such as a sublabial incision to access the maxilla, subciliary or transconjunctival incisions for the orbital rim, or columellar-septal transfixion incisions for 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. During the procedure, the fracture is disimpacted and reduced through multiple surgical approaches, with stabilization achieved using miniplates, screws, and/or interosseous wiring. In certain cases, external fixation techniques, such as a head cap, halo device, or intermaxillary fixation, may be employed either as a primary method or in conjunction with internal fixation, particularly in the presence of extensive panfacial fractures. This comprehensive approach ensures that the fractured segments are properly aligned and stabilized, facilitating optimal healing and recovery.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure associated with CPT® Code 21435 is indicated for the treatment of complicated LeFort III fractures, which may present with the following conditions:
The open treatment of a complicated LeFort III fracture involves several critical procedural steps, which are outlined as follows:
Post-procedure care for patients undergoing the open treatment of a complicated LeFort III fracture typically involves monitoring for complications, managing pain, and ensuring proper healing of the surgical site. Patients may require follow-up imaging to assess the alignment and stability of the fracture. Additionally, instructions regarding activity restrictions and oral care may be provided to facilitate recovery. The overall recovery process will depend on the extent of the fracture and the surgical intervention performed, with a focus on restoring function and aesthetics to the midface.
| Short Descr | OPTX CRNFC SEP COMP INT&/XTR | Medium Descr | OPEN TX CRANIOFACIAL SEP COMP W/INT&/XTRNL FIX | Long Descr | Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and/or external fixation techniques (eg, head cap, halo device, and/or intermaxillary fixation) | 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 |
| 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. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). |
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| 2025-01-01 | Changed | Short Description changed. |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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