21320

🧬CPT Code 21320 — Closed Treatment of Nasal Bone Fracture

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📘 Description

CPT 21320 describes the closed treatment of a nasal bone fracture performed with manipulation and stabilization to realign the nasal bones following trauma.
No skin incisions are made. The provider manually reduces the fracture, often using nasal elevators or instruments inserted through the nostril, then stabilizes it with an external splint or internal packing to maintain alignment.

This procedure restores nasal form and function and is generally performed with local or general anesthesia.

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🩺 Clinical Context

This code is used following nasal trauma such as:

• Sports injuries
• Accidental impacts
• Falls or motor vehicle collisions
  The physician ensures alignment symmetry and patency of the nasal airway after reduction.
  If more complex repair (e.g., open fracture or nasal septum involvement) is required, other codes (e.g., 21315, 21340) may be more appropriate.

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⚙️ Procedure Steps

1. Evaluate fracture via physical exam and imaging.
2. Apply local or general anesthesia.
3. Manually realign displaced nasal bones using elevators or internal instruments.
4. Stabilize bones with:
   • Nasal splint
   • Intranasal packing or external dressing
5. Advise follow-up for alignment check and breathing assessment.

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💡 Coding Guidelines

• Includes:
  • Manipulation and stabilization
  • Application of nasal splints or dressings
  • Follow-up care within the global period
• Excludes:
  • Open treatment of nasal fracture — 21330
  • Closed treatment without manipulation — 21310
  • Septoplasty or other nasal reconstructive procedures — 30520
• Use of Modifiers:
  Apply modifiers per case complexity or re-operation circumstances (see YAML for full list).
• Global Period: 90 days (major surgery).

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🧮 wRVU and Payment Details

Metric	Value	Notes
wRVU	2.10	Based on moderate-complexity fracture care
Assistant Payable	Yes	Assistant at surgery allowed
Average Reimbursement (2025)	$272-$380	Variable by payer and region
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🧾 Related Diagnoses (ICD-10-CM)

Commonly associated ICD-10-CM diagnosis codes for 21320 include:

ICD-10-CM	Description	HCC	Notes
S02.2XXA	Fracture of nasal bones, initial encounter for closed fracture	No	Most common primary diagnosis
S02.2XXD	Fracture of nasal bones, subsequent encounter	No	For follow-up encounters
S00.33XA	Contusion of nose, initial encounter	No	Possible concurrent superficial injury

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🧩 Code Tree (Fracture and/or Dislocation Procedures on the Head)

21310 - Closed treatment of nasal bone fracture; without manipulation  
└── 21315 - Closed treatment, with stabilization only  
└── 21320 - Closed treatment, with manipulation and stabilization  
└── 21325 - Open treatment, with or without internal fixation  
└── 21330 - Open treatment of nasal and septal fracture, separate procedure

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🏥 MS-DRG (if inpatient)

While nasal fracture repair is most often outpatient, if performed inpatient, it may fall under:

MS-DRG	Description	Relative Weight
134	Major Head and Neck Procedures	3.27
136	Other Ear, Nose, Mouth, and Throat Ops	1.29

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💬 Coding Examples

Example 1 - Straightforward Closed Reduction

A patient presents with a displaced nasal bone fracture after a sports injury. The provider manually realigns the bones and applies an external splint.
Code: 21320

Example 2 - Repeat Procedure Due to Re-displacement

The same physician repeats the closed reduction two weeks later because the nasal bones have shifted again.
Code: 21320-76 (Repeat Procedure by Same Physician)

Example 3 - Bilateral Nasal Fracture

Reduction and stabilization required on both nasal sides.
Code: 21320-50 (Bilateral Procedure)

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🧠 Clinical Pearls

• If septal deviation is also corrected, report both 21320 and 30520 only if distinct and documented.
• Avoid reporting with 21310 for the same encounter.
• Post-service care involving removal of nasal splints is included in global service.
• Avoid unbundling unless clearly supported by operative note.

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🧮 Related Codes

Code	Description
21310	Closed treatment, nasal fracture, without manipulation
21315	Closed treatment, without manipulation, with stabilization
21325	Open treatment of nasal fracture, with or without fixation
30520	Septoplasty or submucous resection
21210	Graft procedures for nasal reconstruction

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🪜 Summary

21320 is the primary CPT code for closed reduction of nasal fractures with manipulation and stabilization, reflecting moderate surgical complexity and typically outpatient management.
It includes both the manual reduction of nasal bones and application of stabilizing devices such as splints or packing for healing and symmetry restoration.
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