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The procedure described by CPT® Code 42281 involves the insertion of a pin-retained palatal prosthesis, which is a dental device used to restore function and aesthetics in patients with defects in the palate. A palatal prosthesis is typically custom-fabricated to fit the unique contours of a patient's mouth and is designed to cover defects that may result from congenital conditions, trauma, or surgical resections. During this procedure, the previously made prosthesis is carefully positioned in the oral cavity, specifically over the defect in the palate. The fit of the prosthesis is critically evaluated and adjusted to ensure comfort and functionality. Once the proper fit is confirmed, fixation sites on the maxilla are identified, and drill holes are created to facilitate the secure placement of pins. These pins are then inserted into the drill holes, effectively anchoring the prosthesis in place to provide stability and support for the patient. This procedure is essential for improving the quality of life for individuals with palatal defects, allowing for better speech, swallowing, and overall oral function.
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The insertion of a pin-retained palatal prosthesis, as described by CPT® Code 42281, is indicated for patients who have specific conditions or defects in the palate that necessitate the use of a prosthetic device. These indications may include:
The procedure for the insertion of a pin-retained palatal prosthesis involves several critical steps to ensure proper placement and stability of the device. The following procedural steps are outlined:
Post-procedure care following the insertion of a pin-retained palatal prosthesis is essential for ensuring proper healing and function. Patients may be advised to follow specific oral hygiene practices to maintain the cleanliness of the prosthesis and surrounding tissues. Additionally, clinicians may recommend a follow-up appointment to assess the fit and function of the prosthesis, making any necessary adjustments. Patients should also be monitored for any signs of discomfort or complications, such as irritation at the fixation sites. Overall, the expected recovery involves a period of adjustment as the patient acclimates to the new prosthesis, with ongoing support from dental professionals to ensure optimal outcomes.
| Short Descr | INSERTION PALATE PROSTHESIS | Medium Descr | INSJ PIN-RETAINED PALATAL PROSTHESIS | Long Descr | Insertion of pin-retained palatal prosthesis | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | 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 | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 33 - Other OR therapeutic procedures on nose, mouth and pharynx |
| 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. | 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 |
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| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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