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Topic: Carefully code facial fractures

Ambulatory Surgery Reimbursement Update, April 28, 2008

Coding for procedures to treat facial fractures can be tricky. It can be difficult to understand the exact condition of the patient in the operative notes due to the fact that 60% to 70% of all facial fractures involve the orbit in some way.

“You will often have multiple codes if you are dealing with a facial fracture, a complex procedure,” said Susan Garrison, CPC, CHC, CCS-P, CPC-H, CPAR, executive vice president at Magnus Confidential, Inc., in Dawsonville, GA.

Medicare now covers Le Fort procedures performed in the ASC, so take a moment to understand the difference between Le Fort I, II, and III. Physicians will often document the specific Le Fort procedure they perform, but read the documentation carefully to make sure you always capture the codes correctly.

 

  • Le Fort I is a fracture separating the palate and alveolus from the rest of the maxilla—a fracture which occurs above the roots of the teeth. This mobile maxillary segment moves like a loose denture.
  • Le Fort II separates the mid-face from the skull, creating a free-floating pyramidal segment. This fracture also includes a mobile palate.
  • Le Fort III involves a complete separation of the face from the cranial base. The mobile segment includes the maxilla, palate, zygoma, and ethmoid bones. This is known as “craniofacial separation.”

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