2025 CPT code 21366
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Musculoskeletal System Surgery Feed
Open treatment of complex malar area fractures (including zygomatic arch and malar tripod), with bone grafting.
Modifiers 50 (bilateral procedure), 51 (multiple procedures), 76 (repeat procedure), and others might be applicable depending on the specific scenario.Consult the CPT manual for modifier guidelines.
Medical necessity is established by the presence of a symptomatic, unstable malar fracture that compromises facial aesthetics, function, or ocular integrity.The choice of open reduction versus closed reduction is determined by fracture complexity.Bone grafting might be medically necessary to address significant bony defects.
The clinical responsibility includes pre-operative planning, obtaining informed consent, performing the surgical procedure (including bone graft harvesting, fracture reduction, bone grafting and wound closure), post-operative care, and follow-up.
In simple words: This code describes a surgical repair of a complicated broken cheekbone, often involving multiple breaks or breaks near important nerves.The surgeon will open the skin, fix the broken bones, and use a bone graft (from another part of the body) to fill any gaps.
This CPT code, 21366, signifies the open treatment of complicated fractures in the malar region, encompassing the zygomatic arch and malar tripod.The complexity might involve comminuted fractures or fractures affecting cranial nerve foramina. The procedure includes bone grafting, which involves obtaining the graft material.The code encompasses all steps, from surgical exposure and fracture reduction to bone graft placement and wound closure.
Example 1: A patient presents with a comminuted zygomatic fracture following a motor vehicle accident.The surgeon performs open reduction and internal fixation (ORIF) with bone grafting using autograft from the iliac crest., A patient sustains a complex malar fracture involving the zygomatic arch and the floor of the orbit.The surgeon performs an open reduction and internal fixation with bone grafting using allograft., A patient with a prior malar fracture has experienced a recurrence, requiring revision surgery with open reduction, internal fixation, and bone grafting using a synthetic bone graft material.
Detailed operative report including approach(es), fracture description, type of fixation used, amount and type of bone graft material, details of any complications, and post-operative management.Pre-operative imaging (e.g., CT scans) are needed to document the fracture.Post-operative imaging to assess the quality of bone reduction and fixation.Consent form and relevant medical records.
** Always consult the current CPT manual and payer-specific guidelines for the most up-to-date information on coding, reimbursement, and medical necessity requirements. This information is current as of December 3rd, 2024.
- Revenue Code: P3D (MAJOR PROCEDURE, ORTHOPEDIC - OTHER)
- RVU: This information requires access to current relative value units (RVUs) data.RVUs vary based on geographic location and payer.
- Global Days: The global period for this procedure needs to be determined based on payer-specific guidelines and local standards.It is not explicitly defined in the CPT code description.
- Payment Status: Active
- Modifier TC rule: Not applicable.This procedure is primarily a professional service.
- Fee Schedule: Fee schedule data requires access to historical fee data sources. These vary based on location and payer.
- Specialties:Oral and Maxillofacial Surgery, Plastic Surgery, and possibly Neurosurgery (depending on the location and severity of the fracture)
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, and possibly Office-Based Surgery (depending on the complexity of the procedure and surgeon's setting)