⚕️ICD-10 CM21345 - Open treatment of nasal bone fracture with stabilization

Code Description

ICD-10 CM 21345 represents Open treatment of nasal bone fracture with stabilization. This surgical procedure involves the open reduction and internal fixation (ORIF) of fractured nasal bones using various stabilization methods such as wires, plates, screws, or packing. This code is used when closed reduction methods are insufficient or when the fracture is complex, comminuted, or requires direct visualization for proper alignment.^{AMA CPT}

Clinical Overview

Nasal bone fractures are among the most common facial fractures due to the prominent position of the nose. Open treatment is indicated when closed reduction fails, when fractures are significantly displaced, comminuted, or when there is associated septal deviation requiring correction. The procedure typically involves an incision (often intranasal or external), direct visualization of the fracture site, realignment of bone fragments, and stabilization using internal fixation devices or external splinting. Recovery typically takes 2-6 weeks with activity restrictions.^AAOMS

Coding Hierarchy (Code Tree)

This code exists within the following hierarchy in the CPT structure:

Section: Surgery
- Subsection: Musculoskeletal System
  - Section: Facial Bones
    - Subsection: Fractures
      - Category: Nasal Bones
        
        Code: Open treatment of nasal bone fracture with stabilization (21345)

Official Coding Guidelines & Notes

Includes

This code includes procedures specified as:

Open reduction of nasal bone fracture
Internal fixation of nasal bones
Stabilization with wires, plates, or screws
Open treatment with bone grafting if performed^{AMA CPT}

Bundling & Component Services

Note: Certain services are bundled into 21345 and should not be reported separately.

Local Anesthesia: Included in the surgical package.
Simple Debridement: Minor wound preparation is included.
Nasal Packing: Routine nasal packing for stabilization is included.
Postoperative Care: Routine follow-up care is included in the global period.
Imaging: Preoperative imaging is billed separately if performed.^NCCI

Excludes

Note: Do not use 21345 for these conditions/procedures.

Closed Treatment: If fracture is treated without incision, use 21315 (Closed treatment of nasal bone fracture without manipulation) or 21320 (Closed treatment with manipulation).
Other Facial Fractures: Fractures of maxilla, zygoma, or mandible have separate codes.
Septoplasty Alone: If only septal correction is performed without bone fracture repair, use 30520.
Rhinoplasty: Cosmetic rhinoplasty codes should not be reported with trauma repair unless distinct.^{AMA CPT}

Coding Tips

Documentation: Ensure the operative report clearly documents “open treatment” with incision and direct visualization of the fracture.
Stabilization Method: Document the specific stabilization method used (wires, plates, screws, packing).
Laterality: Nasal bones are midline structures; modifier -50 typically does not apply.
Global Period: This code typically has a 90-day global period; routine postoperative care is bundled.^{CMS MPFS}
Diagnosis Link: Link to the appropriate fracture code from Chapter 19 (Injury, poisoning and certain other consequences of external causes).
Concurrent Procedures: If other facial fractures are repaired, report each separately with appropriate modifiers.^{Coding Clinic}

Reimbursement & Risk Adjustment

HCC (Hierarchical Condition Category)

Status: N/A
Reason: HCC models apply to ICD-10-CM diagnosis codes, not CPT procedure codes. However, the diagnosis driving this procedure (e.g., S02.2XXA) may be HCC eligible.^{CMS Risk Adjustment}

wRVU (Work Relative Value Unit)

Value: Yes (Variable)
Reason: 21345 is assigned a wRVU under the Medicare Physician Fee Schedule (MPFS). The exact value varies annually and by facility vs. non-facility setting.^{CMS MPFS}
Impact: Determines physician reimbursement relative to other services. Typically carries moderate to high wRVU due to surgical complexity.

Assistant Surgeon Payable

Status: Yes
Reason: This code typically allows for an assistant surgeon (modifiers -80, -81, -82) if medically necessary and permitted by payer policy, given the technical nature of the procedure.^{CMS MPFS}

MS-DRG Applicability: No (Inpatient Facility)
Reason: Inpatient hospital reimbursement uses ICD-10-PCS for procedure coding, not CPT. CPT is used for physician billing.
APC Applicability: Yes (Outpatient Facility)
Impact: For outpatient hospital reimbursement, this code maps to an Ambulatory Payment Classification (APC) under OPPS. It typically falls under ENT/Facial Surgery Procedures.^{CMS OPPS}

Coding Examples

Example 1: Acute Nasal Fracture Repair

Scenario: A patient presents to the ER after being struck in the face during a sports accident. CT confirms displaced nasal bone fracture. Patient undergoes open reduction with internal fixation.

Primary Procedure: 21345 (Open treatment of nasal bone fracture with stabilization)
Diagnosis: S02.2XXA (Fracture of nasal bone, initial encounter for closed fracture)
Diagnosis: S00.83XA (Contusion of other part of head, initial encounter)
Note: Specify open vs. closed treatment in documentation.^{Coding Clinic}

Example 2: Delayed Repair with Complications

Scenario: Patient presents 2 weeks after injury with malunited nasal fracture requiring osteotomy and open reduction.

Primary Procedure: 21345 (Open treatment of nasal bone fracture with stabilization)
Diagnosis: S02.2XXD (Fracture of nasal bone, subsequent encounter for fracture with routine healing)
Diagnosis: M84.220A (Nonunion of fracture, right hand) - if applicable
Note: Document the delayed nature and any complications.^{AMA CPT}

Example 3: Combined Facial Fractures

Scenario: Patient sustains multiple facial fractures including nasal and zygomatic bones. Both are repaired during the same session.

Primary Procedure: 21345 (Open treatment of nasal bone fracture with stabilization)
Secondary Procedure: 21365 (Open treatment of zygomatic fracture)
Modifier: -51 (Multiple Procedures) on secondary code
Diagnosis: S02.2XXA (Fracture of nasal bone, initial encounter)
Diagnosis: S02.4XXA (Fracture of malar and maxillary bones, initial encounter)
Note: Report each fracture repair separately.^NCCI

Example 4: Postoperative Complication Return

Scenario: Patient returns to OR within global period for bleeding control after initial nasal fracture repair.

Primary Procedure: 21345
Modifier: -78 (Unplanned Return to the Operating/Procedure Room by the Same Physician for Related Procedure During Postoperative Period)
Diagnosis: T81.03XA (Hemorrhage following procedure, initial encounter)
Note: Modifier -78 reduces reimbursement but indicates related return.^{CMS MPFS}

Common modifiers applicable to 21345:

-22: Increased Procedural Services (if work required is substantially greater than typical).
-24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period.
-51: Multiple Procedures (if other distinct procedures are performed during same session).
-59: Distinct Procedural Service (if performed at a different site or session to bypass NCCI edits).
-76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional.
-77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional.
-78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period.
-79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period.
-80: Assistant Surgeon.
-81: Minimum Assistant Surgeon.
-82: Assistant Surgeon (when qualified resident surgeon not available).
-RT: Right Side.
-LT: Left Side.^{AMA CPT}

Sources

^{AMA CPT} American Medical Association, CPT Professional Edition. ^AAOMS American Association of Oral and Maxillofacial Surgeons, Facial Trauma Resources. ^NCCI CMS National Correct Coding Initiative Policy Manual. ^{Coding Clinic} AHA Coding Clinic for CPT. ^{CMS Risk Adjustment} CMS Medicare Advantage Risk Adjustment Data Processing System. ^{CMS MPFS} CMS Medicare Physician Fee Schedule. ^{CMS OPPS} CMS Outpatient Prospective Payment System.

Explorer

21345