Wiki Osteotomy for access to orbital fracture

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hbair99

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21206 for osteotomy maxilla and 21407 for orbit fx repair. Biller brought to me because insurance denied osteotomy for not sufficient documentation. I tend to agree, but wanted another input on what others have done when the osteotomy is used for access only????

The
anterior maxillary wall was fully visualized, and an osteotomy was created, in a
square form. This was teased off the maxilla, and the maxillary sinus was
entered, allowing visualization of the inferior orbital floor fracture from the
inferior. The removed bone was placed in saline. The R orbital contents were
 
While there is no NCCI edit that bundles 21206 into 21407, I do no think there is enough there to justify billing 21206 . In general, procedures performed to "gain access" are included in the primary procedure.

The procedural description I have for billing 21206 is:

The physician corrects a localized deformity of the maxilla by performing a segmental osteotomy (e.g., Wassmund or Schuchard). The physician creates an incision over the area of the deformity and reflects tissue until the bone segment is isolated. Saws, drills, and osteotomes are used to remove the segment of deformed bone. The maxilla is held in place with wires, screws, metal plates, or an acrylic splint. Internal fixation may or may not be used. All incisions are closed.​

The documentation you provided reads insufficient to me to support code 21206. Hope that helps!
 
Thank you for your input

I am in agreement. Maybe if there was more information as to why they had to go through the maxilla to do the orbital repair, but there is nothing.
Thank you!!! Thank you!!!
 
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