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21407

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⚕️CPT Code 21407 - Open treatment of mandibular fracture, including internal fixation, other than condylar or coronoid process

Code Description

CPT 21407 represents Open treatment of mandibular fracture, including internal fixation, other than condylar or coronoid process. This surgical procedure involves the open reduction and internal fixation (ORIF) of a fractured mandible (lower jaw) using plates, screws, wires, or other fixation devices. This code specifically excludes fractures of the condylar or coronoid processes, which have separate CPT codes.AMA CPT

Clinical Overview

Mandibular fractures are common facial injuries resulting from trauma such as motor vehicle accidents, assaults, sports injuries, or falls. Open treatment with internal fixation is indicated for displaced fractures, multiple fractures, comminuted fractures, or when closed reduction methods are insufficient. The procedure involves surgical exposure of the fracture site, anatomical reduction of bone fragments, and stabilization using rigid internal fixation (plates and screws) or intermaxillary fixation (wiring). Proper alignment is critical for restoring occlusion (bite), facial symmetry, and function. Recovery typically takes 6-8 weeks with dietary 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: Mandible
            • Code: Open treatment of mandibular fracture, including internal fixation, other than condylar or coronoid process (21407)

Official Coding Guidelines & Notes

Includes

This code includes procedures specified as:

  • Open reduction of mandibular fracture (body, angle, symphysis, ramus)
  • Internal fixation with plates, screws, or wires
  • Intermaxillary fixation (IMF) when performed with open treatment
  • Exposure and reduction of fracture fragments
  • Closure of surgical incisionAMA CPT

Bundling & Component Services

Note: Certain services are bundled into 21407 and should not be reported separately.

  • Local Anesthesia: Included in the surgical package.
  • Simple Debridement: Minor wound preparation is included.
  • Intermaxillary Fixation: When performed as part of open treatment, IMF is included.
  • Postoperative Care: Routine follow-up care is included in the global period.
  • Imaging: Preoperative and postoperative imaging (X-rays, CT scans) are billed separately if performed.NCCI

Excludes

Note: Do not use 21407 for these conditions/procedures.

  • Condylar Process Fracture: Use 21411 (Open treatment of mandibular condylar fracture).
  • Coronoid Process Fracture: Use 21413 (Open treatment of mandibular coronoid process fracture).
  • Closed Treatment: If fracture is treated without incision, use 21400 (Closed treatment of mandibular fracture without manipulation) or 21401 (Closed treatment with manipulation).
  • External Fixation: If external fixation device is used, see 21406.
  • Dentoalveolar Fracture: Fractures involving teeth/alveolar ridge have separate codes (21415).AMA CPT

Coding Tips

  • Documentation: Ensure the operative report clearly documents “open treatment” with incision and direct visualization of the fracture.
  • Fracture Location: Document the specific location of the mandibular fracture (body, angle, symphysis, ramus).
  • Fixation Method: Document the specific fixation method used (plates, screws, wires, IMF).
  • Laterality: Mandibular fractures may be unilateral or bilateral; use modifier -50 if bilateral fractures are repaired during the same session.
  • 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
  • Occlusion: Document preoperative and postoperative occlusion status.AAOMS

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., S02.60XA) may be HCC eligible.CMS Risk Adjustment

wRVU (Work Relative Value Unit)

  • Value: Yes (Variable)
  • Reason: 21407 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 and technical requirements.

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 mandibular fixation.CMS MPFS

MS-DRG & APC (Medicare Severity Diagnosis Related Group / Ambulatory Payment Classification)

  • 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 Oral & Maxillofacial Surgery Procedures.CMS OPPS

Coding Examples

Example 1: Acute Mandibular Body Fracture

Scenario: A patient presents to the ER after being struck in the jaw during an assault. CT confirms displaced mandibular body fracture. Patient undergoes open reduction with internal fixation using titanium plates and screws.

  • Primary Procedure: 21407 (Open treatment of mandibular fracture, including internal fixation)
  • Diagnosis: S02.60XA (Fracture of mandible, unspecified site, initial encounter for closed fracture)
  • Diagnosis: S00.83XA (Contusion of other part of head, initial encounter)

Note:

Specify the fracture location and fixation method in documentation.Coding Clinic

Example 2: Multiple Mandibular Fractures

Scenario: Patient sustains bilateral mandibular body fractures from motor vehicle accident. Both sides are repaired during the same session with ORIF.

  • Primary Procedure: 21407 (Open treatment of mandibular fracture, including internal fixation)
  • Modifier: -50 (Bilateral Procedure)
  • Diagnosis: S02.60XA (Fracture of mandible, unspecified site, initial encounter) - bilateral
  • Note: Some payers may require -RT and -LT instead of -50.CMS MPFS

Example 3: Combined Facial Fractures

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

  • Primary Procedure: 21407 (Open treatment of mandibular fracture, including internal fixation)
  • Secondary Procedure: 21365 (Open treatment of zygomatic fracture)
  • Modifier: -51 (Multiple Procedures) on secondary code
  • Diagnosis: S02.60XA (Fracture of mandible, initial encounter)
  • Diagnosis: S02.4XXA (Fracture of malar and maxillary bones, initial encounter)
  • Note: Report each fracture repair separately.NCCI

Example 4: Condylar Fracture (Different Code)

Scenario: Patient presents with mandibular condylar fracture requiring open treatment.

  • Primary Procedure: 21411 (Open treatment of mandibular condylar fracture)
  • Diagnosis: S02.61XA (Fracture of condylar process of mandible, initial encounter)
  • Note: Do not use 21407 for condylar fractures; they have specific codes.AMA CPT

Example 5: Postoperative Complication Return

Scenario: Patient returns to OR within global period for revision due to hardware failure.

  • Primary Procedure: 21407
  • Modifier: -78 (Unplanned Return to the Operating/Procedure Room by the Same Physician for Related Procedure During Postoperative Period)
  • Diagnosis: T84.030A (Mechanical loosening of internal fixation device, initial encounter)
  • Note: Modifier -78 reduces reimbursement but indicates related return.CMS MPFS

Example 6: Closed vs. Open Treatment

Scenario: Patient presents with non-displaced mandibular fracture treated with closed reduction and wiring (no incision).

  • Primary Procedure: 21401 (Closed treatment of mandibular fracture with manipulation)
  • Diagnosis: S02.60XA (Fracture of mandible, unspecified site, initial encounter)
  • Note: Do not use 21407 for closed treatment; reserve for open procedures with incision.AMA CPT

Common modifiers applicable to 21407:

  • -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.
  • -50: Bilateral Procedure (if both sides of mandible are repaired during same session).
  • -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.

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