Summary & Overview
CPT 21335: Open Reduction of Nasal Bone and Nasal Septum Fracture
CPT code 21335 denotes open surgical reduction of nasal bone and nasal septal fractures using an incision to access and realign fracture fragments. This procedure is clinically significant because it addresses both functional and cosmetic consequences of displaced nasal fractures, often requiring operative management to restore airway patency and nasal contour.
Key payers discussed nationally include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and typical sites of service, descriptions of common billing modifiers associated with the service, and context for how the code is used across payers. The publication outlines common payment and coverage considerations, provider billing practices, and where CPT code 21335 sits relative to related facial fracture and nasal repair procedure codes.
The article provides practical benchmarks and policy-relevant points: frequency of use in operative settings, typical ambulatory surgery versus inpatient settings, and common documentation elements that support medical necessity for open nasal fracture treatment. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 21335 describes open treatment of nasal bone and nasal septal fractures involving an incision to access and realign displaced nasal bones and the nasal septum. The procedure restores nasal function and appearance by directly reducing and stabilizing fracture fragments.
Service Type: Open surgical fracture reduction (nasal bones and septum)
Typical Site of Service: Operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 28-year-old male presents to the emergency department after a bicycle collision with facial trauma. He reports nasal deformity, epistaxis, nasal obstruction, and perinasal tenderness. Examination demonstrates external nasal deformity, septal deviation, and localized swelling. Facial radiographs or CT confirm displaced nasal bone fractures with septal involvement requiring operative intervention. The patient is evaluated by an otolaryngologist or facial plastic surgeon, consented for open reduction of nasal fracture, and taken to an operating room or ambulatory surgery center. Under general anesthesia, a small external incision is made to access the fracture site; displaced bony fragments and septal hematoma are reduced, internal splints or packing may be placed, and closure performed. Postoperative care includes nasal packing or splints, analgesia, instructions for head elevation and avoidance of nasal trauma, and follow-up for suture removal and monitoring of cosmetic and airway outcomes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or time is substantially greater than typical for 21335 (document justification). |
23 |