Coding Musculoskeletal System Procedures, Part 2


Vol. 12 •Issue 14 • Page 8
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Coding Musculoskeletal System Procedures, Part 2

Preoperative and Postoperative Diagnoses: Retrognathia.

Procedure Performed: Sliding advancement genioplasty.

Anesthesia: General endotracheal.

Indications for Procedure: Twenty-one-year-old female with retrognathia who desires advancement genioplasty.

Operative Findings: A 4-mm segment of the genioid tubercle was advanced 5 mm anteriorly and secured with two screws. The lateral extent extended approximately 2 cm posteriorly bilaterally over the midline.

Operative Technique: The patient was taken to the operating room and placed on the operating table in a supine position. General nasotracheal anesthesia was obtained. She was draped in the usual sterile fashion. Her face was prepped with Zephiran. The mental region was injected with 1 percent Lidocaine with 1:100,000 Epinephrine.

The lower lip was retracted and approximately a 3-cm incision was made along the mucosa of the lower lip. Incision was carried out with scissors through the mentalis muscle. After going through the mentalis muscle, the dissection was carried down to the periosteum, which was elevated inferiorly down to the inferior extent of the mandible. Dissection was carried bluntly, laterally, on both sides, and mental nerves were preserved.

The mandible was then retracted anteriorly, and the inferior aspect was marked with a pencil. Both sides were marked 4 mm, and the extent of the 4-mm bone advancement was approximately 2 cm on each side.

An oscillating saw was then used to enter this through each bony cortex. Separated with an osteotome, it was then advanced approximately 5 mm. Two holes were drilled obliquely through the advancement tubercle into the superior aspect of the osteotome site, and these were secured with two screws.

After this, the mentalis muscle was closed with interrupted 4-0 chromic stitches. The mucosa was then closed likewise with a running locking 4-0 chromic stitch. A pressure dressing was applied to the chin. The patient tolerated the procedure well.

ICD-9-CM Code:

Preoperative and postoperative: 524.10 Unspecified anomaly of relationship of jaw to cranial base

CPT Codes: To advance the mandible to a better position, an osteotomy of the mandible was performed. It was slid forward approximately 2 cm and secured with screws. Only one section of bone was cut and moved forward. In the CPT code index, look up the terms Genioplasty and Osteotomy where the 21121Ð21123 is listed. After reading the descriptions, you will see that the appropriate code of 21122 for the single osteotomy.

Facility code assignment:

21121 Genioplasty; sliding osteotomy, single piece

Professional code assignment:

21121 Genioplasty; sliding osteotomy, single piece

Brian Bonanno is a senior health care consultant with Medical Learning Inc. (MedLearn), St. Paul, MN.

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