MD wants to code 21195, 21195-59, 20692-59 and 20692-59. The 20692 is for external fixation and the documentation states internal. The CPT 21195 codes reads ?Rami? so that leads me to believe code is bilateral or it would read ramus.

I was looking at code 21196?? Suggestions, please!

PROCEDURE PERFORMED: Bilateral mandibular ramus osteotomies with internal
mandibular distractor device placement.

DESCRIPTION OF PROCEDURE: A 15blade scalpel was used to sharply incise the skin. Deep dissection was performed bluntly with tenotomy scissors down to the level of the mandible, first on the right and then on the left. A periosteal elevator was used to raise the soft tissue from the mandible in a subperiosteal plane. The mandibular distraction device is then cut to have a total of 4 holes in the plate on each side of the planned osteotomy and then placed in the planned vector for distraction and then fixated in place with 8 titanium screws. The screws are then removed. The osteotomy was performed with a reciprocating saw without difficulty. The inferior alveolar nerve is identified and noted to be intact at the end of the osteotomy. The device is replaced, distracted out to 5mm and then returned to a total of 1 mm distraction. The wound was then copiously irrigated. The deep layers reapproximated with 3-0 Vicryl sutures.The skin edges were reapproximated with 4-0 deep dermal sutures and the skin
edges were reapproximated with skin glue.

Attention was then directed to the left side where the same procedure is
performed. The inferior alveolar nerve is noted to be intact at the completion of the osteotomy. A total of 1 mm of distraction was maintained on the table. The wound was closed without difficulty in the same manner as the right side