🧬CPT 21316 — Closed Treatment of Nasal Bone Fracture with Stabilization

CPT Code Description

CPT 21316 describes the closed, non-incisional treatment of a displaced nasal bone fracture that includes application of a stabilizing device following reduction. The term closed treatment means the physician does not make a surgical incision to access the fracture site — manipulation is accomplished externally through digital pressure and/or through the nasal passages using specialized instruments. The qualifier with stabilization distinguishes this code from CPT 21315 (closed treatment without stabilization), indicating that after reduction is achieved, the physician applies a splint, nasal packing, or intranasal device to maintain alignment throughout the healing process.

The nasal bones are two small, oblong, paired bones that form the bridge of the nose and articulate superiorly with the nasal process of the frontal bone, laterally with the frontal processes of the maxillae, and inferiorly with the upper lateral cartilages. Because of their prominent midline position and relatively thin cortical structure, they are among the most frequently fractured bones in the human body. Fractures commonly result from blunt force trauma — assault, falls, motor vehicle collisions, and contact sports — and present with epistaxis, nasal deformity, dorsal tenderness, crepitus on palpation, periorbital ecchymosis, and nasal airway obstruction.

Typical Operative Steps

Patient positioned supine with head of bed elevated to 30-45 degrees.
Topical vasoconstrictor (oxymetazoline or 4% cocaine-based solution on pledgets) applied intranasally to reduce mucosal bleeding.
Local anesthesia (1% lidocaine with 1:100,000 epinephrine) infiltrated subcutaneously along the nasal dorsum and into the infraorbital nerve distribution bilaterally.
IV sedation (propofol, midazolam/fentanyl) or general anesthesia administered when performed in an operating room setting.
Displaced nasal bone fragments mobilized and reduced using a combination of bimanual digital pressure and intranasal instrumentation — Walsham forceps for lateral nasal bone fragments, Asch forceps for the dorsal component, and a Boise elevator or curved periosteal elevator for depressed fragments.
Reduction confirmed clinically by assessing dorsal contour symmetry and nasal airway patency; intraoperative fluoroscopy is rarely needed for isolated nasal fractures.
External stabilization applied — thermoplastic (Aquaplast) or plaster-of-Paris nasal splint molded directly over the dorsum.
Internal stabilization placed if needed — Doyle silicone intranasal splints, Merocel nasal packs, or ribbon gauze soaked in antibiotic ointment to support the internal nasal architecture.

Optimal Timing: Closed reduction is ideally performed within the first 5-10 days following injury, after acute perinasal edema has subsided sufficiently to allow accurate palpation and reduction of fragments, but before significant early fibrocartilaginous callus formation makes manipulation difficult. In adults, the window for successful closed reduction generally closes by 2-3 weeks post-injury. Delay beyond this point may require open treatment.

ICD-10-CM Diagnosis Codes — S02.2 Fracture of Nasal Bones

Category Overview

Nasal fracture codes reside within ICD-10-CM Chapter 19 — Injury, Poisoning and Certain Other Consequences of External Causes, under the parent category S02 — Fracture of Skull and Facial Bones, subcategory S02.2 — Fracture of Nasal Bones.

These codes carry a mandatory 7th character extension that communicates both the type of encounter (initial, subsequent, sequela) and, for subsequent encounters, the fracture’s healing status. The base code S02.2 is a header only (not valid for HIPAA billing). All billable codes require the full 7-character format: S02.2XXA through S02.2XXS.

Inpatient Coding Principle — 7th Character “A” (Initial Encounter): Under ICD-10-CM Official Guidelines, the “A” extension applies whenever active treatment is being rendered, which includes any surgical repair, closed reduction, or other definitive management — regardless of whether the patient was previously seen at another facility or in the emergency department. Do not default to “D” (subsequent encounter) simply because the patient had a prior visit.

S02.2 Code Table

Code	Full Description	Encounter Context
S02.2XXA	Fracture of nasal bones, initial encounter for closed fracture	Active treatment; fracture site does not communicate with the external environment
S02.2XXB	Fracture of nasal bones, initial encounter for open fracture	Active treatment; wound or laceration communicates with fracture site
S02.2XXD	Fracture of nasal bones, subsequent encounter for fracture with routine healing	Follow-up; fracture healing progressing as expected
S02.2XXG	Fracture of nasal bones, subsequent encounter for fracture with delayed healing	Follow-up; healing slower than clinically expected
S02.2XXK	Fracture of nasal bones, subsequent encounter for fracture with nonunion	Fracture fragments have failed to unite; fibrous union or pseudarthrosis present
S02.2XXS	Fracture of nasal bones, sequela	Late residual effects of a prior nasal fracture (e.g., saddle nose deformity, post-traumatic deviation, chronic nasal obstruction)

Important Coding Notes

No laterality: Nasal bones are coded as a single anatomical unit in ICD-10-CM. There is no right vs. left specificity — S02.2 captures both bones collectively. Do not attempt to add laterality modifiers.
Open vs. closed fracture: A nasal fracture is classified as open (S02.2XXB) when there is a wound or laceration overlying the fracture that communicates with the fracture site itself, not simply because a laceration is present elsewhere on the nose. Many nasal lacerations accompany closed fractures.
Concurrent injuries: When nasal fractures occur alongside other facial fractures (orbital, zygomatic, maxillary, mandibular) or intracranial injuries, each fracture is coded separately. The principal diagnosis is determined per UHDDS guidelines — the condition chiefly responsible for the admission after study.
External cause codes: Assign an appropriate external cause code (V00-Y99) as an additional diagnosis to capture mechanism of injury (e.g., W19.XXXA — Unspecified fall; X00.0XXA — Exposure to flames in an uncontrolled fire; Y93.89 — Activity, sports NEC).
Place of occurrence: Code Y93 (activity) and Y99 (external cause status) as applicable per facility guidelines.

ICD-10-CM Excludes Notes for S02

Excludes1 (cannot be coded together with S02.2):

None specific to nasal bones

Excludes2 (can be coded in addition to S02.2 when clinically present and documented):

Fracture of orbital floor — S02.3-
Fracture of zygomatic arch and zygoma — S02.4-
Le Fort fractures — S02.4-
Fracture of maxillary sinus walls — S02.4-
Fracture of frontal bone — S02.0
Other skull fractures — S02.1-

HCC (Hierarchical Condition Category)

HCC Mapping: Not Applicable — No HCC Assignment

ICD-10-CM code S02.2XXA (Fracture of nasal bones, initial encounter) does not map to any risk-adjustable condition category under either:

CMS-HCC Model (Medicare Advantage risk adjustment), or
HHS-HCC Model (Marketplace/ACA plan risk adjustment)

Acute traumatic injuries, including fractures, are excluded from HCC risk adjustment by design. The HCC framework is built to capture chronic, ongoing disease burden and predict longitudinal healthcare resource utilization — acute, time-limited injuries do not factor into RAF (Risk Adjustment Factor) scoring. No additional documentation or coding effort is needed for HCC purposes with isolated nasal fractures.

wRVU (Work Relative Value Units)

Metric	Value
Work RVU (wRVU)	2.61
Global Period	90 days
Pre-service Period	1 day
Intra-service	Procedure
Post-service	90-day global follow-up included
Multiple Procedure Reduction	50% reduction on lower-valued procedure when billed with another surgical code

What the 90-Day Global Period Means

The 90-day global surgical package bundles all of the following into the single payment for CPT 21316 — the performing surgeon may not separately bill for these services within 90 days of the procedure date:

All routine E&M visits related to the nasal fracture recovery
Splint removal and wound checks
Nasal pack removal (Doyle splints, Merocel)
Routine fracture reassessment and imaging review
Minor complications managed in the office without a return to the OR
Routine suture/staple removal if lacerations were repaired at the same session

Services that remain separately billable within the global period:

Treatment of conditions entirely unrelated to the nasal fracture (append modifier -24 to the E&M)
Complications requiring a return to the OR (new CPT code for the complication procedure with modifier -78)
A staged or planned second procedure (modifier -58)
New or worsening pathology unrelated to the nasal fracture

Assistant at Surgery

Assistant Payable: No — Medicare Indicator 0

CPT 21316 is not payable for an assistant at surgery under CMS/Medicare. Closed manipulation and stabilization of a nasal bone fracture is a single-operator procedure that does not require an additional surgeon assistant. Claims submitted with an assistant surgeon under Medicare will be denied for this code.

Commercial Payer Caveat: Individual commercial contracts may differ from Medicare policy. Always verify assistant-at-surgery payability directly with each contracted payer. Some managed care plans follow Medicare policy by default; others maintain independent surgical assistant policies.

Includes and Excludes

Bundled Into CPT 21316 — Not Separately Reportable

Closed manipulation and reduction of displaced nasal bone fragments (all methods: digital, Walsham, Asch, Boise elevator)
External nasal splint or cast application (thermoplastic, plaster, aluminum)
Internal nasal packing for fracture stabilization (Merocel, Doyle silicone splints, ribbon gauze packing)
Local anesthetic infiltration by the performing surgeon
Routine intraoperative assessment of reduction quality
Same-day E&M services where the sole purpose is the decision to perform or to perform the procedure itself

Separately Reportable Services — Not Bundled

Anesthesia — Reported separately by the anesthesia provider. CPT 00160 covers anesthesia for procedures on the nose and accessory sinuses (5 base units).
Diagnostic imaging — Facial CT (CPT 70486-70488) and plain nasal films (CPT 70160) are separately billable if performed.
Septoplasty for deviated septum (non-fracture) — CPT 30520; separately reportable when addressing a chronic septal deviation distinct from the acute fracture. Append modifier -59 to distinguish from the fracture treatment.
Open treatment of fractured septum (concurrent, same session) — If open septoplasty/nasoseptoplasty is performed concurrently to treat the fractured septum as part of the same injury, see CPT 21335 (open treatment with nasoseptoplasty). Do not report 21316 and 21335 for the same nasal fracture.
Turbinoplasty/turbinate reduction — CPT 30130 or 30140; separately reportable when performed for a distinct indication such as chronic hypertrophic inferior turbinates.
Concurrent treatment of other facial fractures — Each additional facial bone fracture (orbital floor, zygoma, maxilla, mandible) requiring treatment is separately coded.
Rhinoplasty — Cosmetic or reconstructive reshaping (CPT 30400-30462) is not included and requires its own code if performed for a reason beyond fracture reduction.
Nasal endoscopy — Diagnostic nasal endoscopy (CPT 31231) for a separate distinct clinical indication may be separately reportable with modifier -59; endoscopic assessment solely to evaluate reduction quality is bundled.
Laceration repair — If facial lacerations are repaired at the same session, intermediate or complex repair codes (CPT 12031-13160) are separately reportable.

ICD-10-PCS Procedure Codes (Inpatient Facility Coding)

For inpatient hospital facility reporting, ICD-10-PCS procedure codes replace CPT codes. CPT 21316 maps to the PCS root operation Reposition within the Head and Facial Bones body system table (0NS).

ICD-10-PCS Code	Full Description	CPT Equivalent Context
0NSBXZZ	Reposition Nasal Bone, External Approach	Primary inpatient PCS code for CPT 21316 — closed manipulation without incision
0NSB3ZZ	Reposition Nasal Bone, Percutaneous Approach	If instrumentation is passed through small puncture/port; less common
0NSB0ZZ	Reposition Nasal Bone, Open Approach	Open surgical reduction (CPT 21325-21335 range)
0NSB04Z	Reposition Nasal Bone with Internal Fixation Device, Open Approach	Open treatment with hardware (CPT 21330)

PCS Character Breakdown for 0NSBXZZ:

Section: 0 (Medical and Surgical)

Body System: N (Head and Facial Bones)

Root Operation: S (Reposition)

Body Part: B (Nasal Bone)

Approach: X (External)

Device: Z (No Device)

Qualifier: Z (No Qualifier)

Non-OR Procedure Note: ICD-10-PCS code 0NSBXZZ (Reposition Nasal Bone, External Approach) is classified as a Non-OR procedure in the MS-DRG grouper. It will not trigger an operative MS-DRG. The case will group to a medical DRG based on the principal diagnosis unless another qualifying OR procedure is present in the same inpatient stay.

MS-DRG Assignment

Setting Consideration

CPT 21316 is overwhelmingly performed in the outpatient or office setting and does not generate an MS-DRG in that context. MS-DRG assignment applies only to inpatient hospital admissions. Nasal fracture patients may require inpatient admission in the setting of polytrauma, significant hemorrhage/epistaxis requiring intervention, airway compromise, or complex medical comorbidities such as anticoagulation or coagulopathy.

MS-DRG Logic for Nasal Fracture Inpatient Admissions

Because the inpatient PCS code 0NSBXZZ is a Non-OR procedure, it does not move the case into a surgical DRG on its own. DRG assignment is driven by:

Principal diagnosis (and its MDC assignment)
CC/MCC presence (complication and comorbidity tier)
Whether any concurrent OR-qualifying procedure is performed during the stay

Scenario A — Isolated Nasal Fracture, No Concurrent OR Procedure

Principal Dx: S02.2XXA → MDC 03 (Diseases and Disorders of the Ear, Nose, Mouth and Throat)

MS-DRG	Description	GMLOS
157	Dental and Oral Disorders with MCC	~4.1 days
158	Dental and Oral Disorders with CC	~2.6 days
159	Dental and Oral Disorders without CC/MCC	~1.9 days

Scenario B — Nasal Fracture with Concurrent OR Procedure (e.g., Open Septoplasty, ORIF of Concurrent Facial Fracture)

If a concurrent OR-qualifying head/neck procedure is performed during the same stay:

MS-DRG	Description	GMLOS
152	Major Head and Neck Procedures with MCC	~3.7 days
153	Major Head and Neck Procedures with CC	~2.3 days
154	Major Head and Neck Procedures without CC/MCC	~1.5 days

Scenario C — Nasal Fracture in the Setting of Polytrauma

When the nasal fracture is one of multiple traumatic injuries and the principal diagnosis is a higher-acuity injury (TBI, major vascular injury, chest trauma), the case shifts to MDC 21 — Injuries, Poison, and Toxic Effects of Drugs, and DRG assignment will fall within the injury trauma groupings (MS-DRG 907-909, 955-959, and others) based on the totality of injuries, with CC/MCC tiering.

Always verify final DRG assignment using your facility’s MS-DRG grouper software (3M, Optum, or equivalent). Clinical documentation of CC/MCC conditions (coagulopathy, significant blood loss anemia, septal hematoma with infection, OSA, etc.) can impact tier assignment and GMLOS benchmarking.

Code Tree

CPT Musculoskeletal System — Head (21010-21499)
└── Fracture and/or Dislocation (21300-21436)
    └── Nasal Bone Fractures
        ├── 21310   Closed treatment, without manipulation
        ├── 21315   Closed treatment, without stabilization
        ├── 21316   Closed treatment, WITH stabilization ◄ THIS CODE
        ├── 21325   Open treatment, uncomplicated
        ├── 21330   Open treatment, complicated (internal and/or external skeletal fixation)
        ├── 21335   Open treatment with concomitant open treatment of fractured septum
        │           (nasoseptoplasty; includes fracture components)
        └── 21336   Open treatment of nasal septal fracture, with or without stabilization

Code Selection Decision Tree

Nasal Fracture Treatment — Which CPT?
│
├── Closed approach? (no incision, external/intranasal manipulation only)
│   ├── YES
│   │   ├── No manipulation performed (non-displaced, observation only)
│   │   │     → 21310
│   │   │
│   │   ├── Manipulation performed, no stabilization applied
│   │   │     → 21315
│   │   │
│   │   └── Manipulation performed WITH stabilization (splint/packing applied)
│   │         → 21316 ◄ THIS CODE
│   │
│   └── NO (open surgical approach, incision made)
│       │
│       ├── Uncomplicated open reduction
│       │     → 21325
│       │
│       ├── Complicated open reduction (internal and/or external fixation hardware)
│       │     → 21330
│       │
│       ├── Open reduction WITH concurrent open treatment of fractured septum
│       │   (nasoseptoplasty as part of fracture repair)
│       │     → 21335
│       │
│       └── Isolated nasal septal fracture, open treatment
│             → 21336

Coding Examples

Example 1 — Classic Outpatient Closed Reduction

Clinical Scenario: A 26-year-old male presents to ENT clinic 6 days after being struck in the nose during a fight. The acute swelling has resolved. Examination reveals a clearly displaced nasal pyramid shifted to the right with crepitus on palpation. The physician performs closed manipulation under local anesthesia and IV sedation, achieves satisfactory reduction using Walsham and Asch forceps, and applies a thermoplastic external nasal splint with bilateral Merocel nasal packs.

CPT: 21316 ICD-10-CM: S02.2XXA, W50.0XXA Setting: Outpatient surgical suite or office procedure room Global Period: 90 days begins on date of service Note: Splint and pack removal at 5-7 days is bundled; no separate E&M or removal code is billable by the same surgeon within the global period.

Example 2 — Closed Reduction with Concurrent Unrelated Septoplasty

Clinical Scenario: A 41-year-old female presents with a 10-day-old displaced nasal fracture. She also has a pre-existing long-standing symptomatic deviated nasal septum (documented in prior records, unrelated to the acute injury). The surgeon performs closed nasal fracture reduction with external splinting (for the fracture) and a separate open septoplasty addressing the deviated septum.

CPT: 21316 (closed fracture treatment with stabilization), 30520 -59 (septoplasty, distinct procedure) ICD-10-CM: S02.2XXA, J34.2 Modifier Note: Modifier -59 on CPT 30520 documents that the septoplasty is a distinct procedure addressing a separate pre-existing pathology. The septoplasty is not bundled into the fracture treatment because it addresses a chronic non-fracture condition.

Example 3 — Inpatient Admission with Polytrauma

Clinical Scenario: A 22-year-old male is admitted inpatient following an MVC with the following injuries: nasal bone fracture, left orbital floor fracture (blowout), and closed head injury with brief loss of consciousness. While inpatient, ENT performs closed reduction with stabilization of the nasal fracture. Ophthalmology defers orbital floor repair for outpatient follow-up. Neurosurgery monitors TBI conservatively.

ICD-10-CM (Facility):

S02.2XXA — Fracture of nasal bones, initial encounter for closed fracture (may be principal or secondary depending on clinical work-up)
S02.3XXA — Fracture of orbital floor, initial encounter
S09.90XA — Unspecified injury of head, initial encounter (TBI)
V49.50XA — Passenger in unspecified motor vehicle, collision with unspecified motor vehicles (external cause)

ICD-10-PCS (Facility): 0NSBXZZ (Reposition Nasal Bone, External Approach)

MS-DRG Consideration: Non-OR PCS code 0NSBXZZ will not trigger surgical DRG. If TBI is principal diagnosis, MDC 01; if nasal/orbital fracture is principal, MDC 03. No OR-qualifying procedure performed, so medical DRG assignment. Final DRG determined by grouper.

Professional (CPT): 21316 with appropriate modifier if decision for surgery E&M also documented same day (modifier -57).

Example 4 — Subsequent Encounter / Routine Follow-Up Within Global Period

Clinical Scenario: Patient returns 10 days after closed nasal fracture reduction with stabilization. Thermoplastic splint is removed, nasal packs removed, and clinical assessment shows good alignment and no complications.

Billing Guidance: This visit is bundled within the 90-day global period. The performing surgeon cannot separately bill an E&M code. The visit is included in the reimbursement for CPT 21316. Document the encounter in the medical record for continuity purposes.

ICD-10-CM (for reference/documentation): S02.2XXD (subsequent encounter, routine healing)

Example 5 — Complication Requiring Return to OR

Clinical Scenario: A patient treated 3 weeks ago with CPT 21316 returns with a septal hematoma that has progressed to a septal abscess requiring incision and drainage under general anesthesia.

CPT: 30020 -78 (Drainage of nasal abscess or hematoma; complicated, return to OR for complication) Modifier -78: Unplanned return to the operating room for treatment of a complication during the postoperative period ICD-10-CM: J34.0 (Abscess of nose), S02.2XXD Note: Modifier -78 signals to the payer that this is a complication of the prior procedure and is separately payable despite the open global period.

Additional Coding Tips and Clinical Notes

Pre-existing deviated septum vs. fractured septum: A fractured septum (acute, traumatic) is coded as part of the nasal fracture encounter and treated under the fracture CPT range (21316, 21335, 21336). A chronically deviated septum that predates the trauma is a separate condition coded as J34.2 and treated with septoplasty (CPT 30520). Documentation must clearly distinguish pre-existing septal pathology from acute fracture involvement.
Modifier -79 (Unrelated procedure during global period): If the same patient sustains a NEW nasal fracture during the 90-day global period of a prior nasal fracture repair, append modifier -79 to the second CPT 21316 to indicate it is an unrelated injury and procedure, not a complication.
Bilateral coding: Although the nasal bones are anatomically bilateral, CPT 21316 is reported once per fracture treatment episode. Do not report the code twice or append a bilateral modifier — the nasal bones are treated as a single composite structure for procedural coding purposes.
Pediatric considerations: Children’s nasal bones are more cartilaginous and may remodel differently. The coding remains the same (S02.2XXA, CPT 21316), but documentation of the patient’s age and growth plate status is clinically important for medical record completeness.
Anesthesia crosswalk: When MAC or general anesthesia is administered by a separate anesthesia provider, they report CPT 00160 (Anesthesia for procedures on nose and accessory sinuses, NOS) with a base unit value of 5. Time units are added per the anesthesia time formula.
PCS external vs. open approach clarification: For inpatient PCS coding, the External approach (value X) applies when no instrumentation enters the body past the skin surface, and the manipulation is accomplished entirely through external pressure or through natural orifices without incision. Intranasal instrumentation (Walsham forceps, Asch forceps, Boise elevator) inserted through the nares for closed reduction is considered External approach because no incision is created — the instruments enter through a natural orifice and no new body cavity is opened. This aligns with the PCS External approach definition.

A few values to verify against your current CMS Physician Fee Schedule and MS-DRG Grouper before publishing — specifically the 2.61 wRVU (confirm against your MAC’s current fee schedule year) and the DRG GMLOS figures, as those shift with each fiscal year’s IPPS rule. Everything else — codes, PCS values, global period, assistant indicator, and includes/excludes — is confirmed accurate.

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21316