Summary & Overview
CPT 21338: Reduction of Nasal and Ethmoid Bone Fracture via Nasal Incision
CPT code 21338 designates an open reduction or realignment of nasal and ethmoid bone fractures via a nasal incision to restore function and cosmetic appearance. This surgical procedure addresses displaced fractures of the nasal skeleton and adjacent ethmoid structures and is relevant for patients presenting after facial trauma. Nationally, accurate coding of this procedure affects surgical case mix reporting, claims adjudication, and payment for specialist services in acute-care settings.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common payment and billing considerations, and reference points for where the procedure is typically performed. The publication summarizes benchmarks and policy-relevant points such as code definition, service setting, and clinical indications, and highlights areas where additional payer-specific guidance may be required.
This overview helps clinical coders, billing professionals, and policy analysts understand the procedural scope of CPT code 21338, its place within facial trauma care, and the types of documentation and surgical settings commonly associated with its use. Data not available in the input where payer-specific rates, diagnosis pairings, and utilization metrics would normally appear.
Billing Code Overview
CPT code 21338 describes the reduction or realignment of a fracture involving the nasal and ethmoid bones performed through a nasal incision. Service type: open fracture reduction of nasal and ethmoid bones. Typical site of service: operative suite or hospital surgical setting, often performed by oral and maxillofacial surgeons, otolaryngologists, or facial plastic surgeons.
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Clinical & Coding Specifications
Clinical Context
A 28-year-old male presents to the emergency department after a motor vehicle collision with facial trauma, nasal deformity, epistaxis, nasal obstruction, and periorbital ecchymosis. On exam there is tenderness and step-off over the nasal dorsum and medial canthus; facial CT confirms displaced fractures of the nasal bones and adjacent ethmoid complex. The patient undergoes operative reduction via a trans-nasal incision under general anesthesia to realign nasal and ethmoid bones, restore airway patency and cosmetic contour, and control septal or mucosal injury. Typical workflow includes preoperative evaluation and imaging, operative reduction of the nasal and ethmoid fractures through a nasal incision, possible internal stabilization (nasal packing or splints), postoperative monitoring in the PACU, and outpatient wound and airway follow-up. Typical site of service is an ambulatory surgical center or hospital operating room with otolaryngology or facial/plastic surgery performing the procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when a distinct E/M service is provided on the same day as the fracture reduction (Note: 25 was not in the provided modifier list; see selected list below). |