{"id":180639,"date":"2026-08-17T08:21:23","date_gmt":"2026-08-17T08:21:23","guid":{"rendered":"https:\/\/pabau.com\/?p=180639"},"modified":"2026-08-17T08:21:25","modified_gmt":"2026-08-17T08:21:25","slug":"cpt-code-21387","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/","title":{"rendered":"CPT code 21387: Orbital blowout fracture, combined approach"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 21387: Open treatment of orbital floor blowout fracture, combined approach\",\"description\":\"CPT code 21387 covers open treatment of an orbital floor blowout fracture through a combined periorbital and transantral approach. Learn the descriptor, the 21385 to 21395 family, ICD-10 pairings, modifiers, RVUs, and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21387\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-07\",\"dateModified\":\"2026-08-17\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 21387 covers open treatment of an orbital floor blowout fracture through a combined approach, using periorbital and transantral access together.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Approach separates 21385, 21386, and 21387. Implant and graft placement separate 21390 and 21395.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>A repair done through one periorbital incision codes to 21386, so the operative note has to name every access route used.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Pair the claim with a laterality-specific diagnosis such as S02.31XA. The old S02.3XXA family was deleted on October 1, 2016.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau keeps claims and clinical records in one system, so what you submit matches what you documented.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 21387 covers open treatment of an orbital floor blowout fracture through a combined approach. The surgeon reaches the fracture by two routes in the same session: a periorbital incision and a transantral window through the maxillary sinus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The code is often described as the \u00ab\u00a0without implant\u00a0\u00bb version of 21386. That is wrong, and it is an expensive mistake. Implant status never appears in the 21387 descriptor. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This reference covers the correct descriptor, the 21385 to 21395 family, ICD-10 pairings, modifiers, reimbursement, and the operative note wording that supports the claim.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-cpt-code-21387-definition-and-clinical-description\" class=\"wp-block-heading\">CPT code 21387: Definition and clinical description<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 21387 sits in the Fracture and\/or Dislocation Procedures on the Head section of the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">AMA&rsquo;s CPT code set<\/a>. It is an indented child code, so its short descriptor only makes sense when you read it with the parent stem at 21385.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21387<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of orbital floor blowout fracture; combined approach<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">What \u00ab\u00a0combined\u00a0\u00bb means<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Periorbital access and transantral (Caldwell-Luc) access in the same operative session<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT section<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture and\/or Dislocation Procedures on the Head (Skull, Facial Bones)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code family<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21385 to 21395, the orbital floor blowout fracture series<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">090 days<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical setting<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Inpatient hospital or ambulatory surgical center (ASC)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical billing providers<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Oculoplastic surgeons, ENT surgeons, and facial plastic or maxillofacial surgeons<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active. Verify the current fiscal year status through the CMS fee schedule.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">One element decides this code, and it is the access route. Nothing in the descriptor refers to an implant, a graft, or fixation hardware. If the note describes one incision, 21387 is the wrong code.<\/p>\n\n\n\n<h2 id=\"h-procedure-description-what-21387-covers\" class=\"wp-block-heading\">Procedure description: What 21387 covers<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">An orbital floor blowout fracture happens when blunt trauma to the orbit drives the thin bony floor down toward the maxillary sinus. Orbital fat or the inferior rectus muscle can herniate through the defect. That produces diplopia, enophthalmos, or hypoglobus, and it is what makes open repair necessary.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Blowout fractures usually follow assault, a fall, or a sports impact. The CT often arrives with the patient from an emergency department or a <a href=\"https:\/\/pabau.com\/industry\/sports-medicine-software\/\">sports medicine practice<\/a>. Attach that report to the surgical record, because the claim leans on it for medical necessity.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A combined repair uses two windows onto the same fracture. The periorbital incision gives the surgeon a direct view of the orbital rim and floor from above. The transantral route opens the maxillary sinus from below, so the surgeon can support the floor and confirm the reduction from the antral side.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The work covered by a single 21387 line includes:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The periorbital incision, usually transconjunctival or subciliary, to expose the orbital floor<\/li>\n\n\n\n<li>The transantral (Caldwell-Luc) antrostomy to reach the floor from beneath<\/li>\n\n\n\n<li>Release and reduction of herniated orbital fat or extraocular muscle back into the orbit<\/li>\n\n\n\n<li>Repositioning and support of the fractured floor fragments<\/li>\n\n\n\n<li>Irrigation, hemostasis, and layered closure of both access sites<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Both approaches sit inside this one code. Reporting 21385 and 21386 together for the same repair is unbundling, and payers deny it on National Correct Coding Initiative edits.<\/p>\n\n\n\n<h2 id=\"h-clinical-indications-when-to-use-21387\" class=\"wp-block-heading\">Clinical indications: When to use 21387<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Surgeons reach for a combined approach when one window will not do the job. The clinical picture, not the coder, decides that. These are the scenarios that usually justify it.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>A large or posterior defect:<\/strong> the fracture extends beyond the reach of a transconjunctival view alone<\/li>\n\n\n\n<li><strong>Comminution:<\/strong> multiple floor fragments need support from below while they are held in position<\/li>\n\n\n\n<li><strong>Trapped tissue:<\/strong> incarcerated muscle or fat that will not release from the orbital side alone<\/li>\n\n\n\n<li><strong>Concurrent maxillary sinus disease or fracture:<\/strong> the antrum has to be entered anyway<\/li>\n\n\n\n<li><strong>Uncertain reduction:<\/strong> the surgeon wants to confirm floor position from the antral side before closing<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">If the surgeon planned a combined approach and then completed the repair through the eyelid alone, bill 21386. The code follows what was done, not what was scheduled.<\/p>\n\n\n\n<h2 id=\"h-related-cpt-codes-21385-21386-21390-and-21395\" class=\"wp-block-heading\">Related CPT codes: 21385, 21386, 21390, and 21395<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Five codes cover open repair of an orbital floor blowout fracture. Three of them are separated by access route, and two by what the surgeon places in the orbit. Mixing those two axes is the single most common error on these claims.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Descriptor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Access route<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Implant or graft<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21385<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of orbital floor blowout fracture; transantral approach (Caldwell-Luc type operation)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Transantral only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not part of the descriptor<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21386<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of orbital floor blowout fracture; periorbital approach<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Periorbital only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not part of the descriptor<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21387<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of orbital floor blowout fracture; combined approach<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Periorbital and transantral<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not part of the descriptor<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21390<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Periorbital<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Alloplastic or other implant placed<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21395<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Periorbital<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bone graft, with harvest included<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Notice what the family does not contain. There is no code for a combined approach with an implant, and no code for a transantral approach with a graft. That absence is where most 21387 disputes start.<\/p>\n\n\n\n<h3 id=\"h-cpt-21387-vs-cpt-21386-the-key-difference\" class=\"wp-block-heading\">CPT 21387 vs CPT 21386: The key difference<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The difference is the number of access routes, not implant status. CPT 21386 covers a repair done entirely through a periorbital incision, whether that is transconjunctival or subciliary. CPT 21387 covers the same fracture reached through a periorbital incision plus a transantral window.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Plenty of coding write-ups still describe 21386 as \u00ab\u00a0with implant\u00a0\u00bb and 21387 as \u00ab\u00a0without implant\u00a0\u00bb. No AMA descriptor has ever read that way. A claim built on those summaries will not survive a records request.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So the operative note has to name every incision. A note that says \u00ab\u00a0the orbital floor was exposed and the fracture reduced\u00a0\u00bb supports neither code. For <a href=\"https:\/\/pabau.com\/blog\/best-plastic-surgery-software\/\">plastic surgery software<\/a> users, an operative template with a required approach field settles this at the point of documentation.<\/p>\n\n\n\n<h3 id=\"h-cpt-21387-vs-cpt-21390-and-21395\" class=\"wp-block-heading\">CPT 21387 vs CPT 21390 and 21395<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21390 and CPT 21395 both describe a periorbital approach. What sets them apart is reconstruction material. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21390 applies when the surgeon places an alloplastic or other implant, such as titanium mesh or porous polyethylene. CPT 21395 applies when the surgeon places a bone graft, and the descriptor already includes harvesting that graft.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Do not bill a separate graft harvest code alongside 21395. The harvest is bundled into the descriptor, and billing it again is a straightforward unbundling denial.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The awkward case is a combined approach that also uses an implant. No single code describes it. Most payers expect the implant code, with an operative note that documents both access routes, and some coders append modifier -22 for the added work. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Confirm the expectation with the payer before you submit, because there is no national rule here. For implant-based repair of orbital fractures outside the blowout family, see <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21407\/\">CPT code 21407<\/a>.<\/p>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-linked-to-cpt-code-21387\" class=\"wp-block-heading\">ICD-10 diagnosis codes linked to CPT code 21387<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every CPT 21387 claim needs a paired ICD-10-CM code that establishes medical necessity. Orbital floor fracture codes became laterality-specific on October 1, 2016. The old non-lateral codes S02.3XXA, S02.3XXB, and S02.3XXD were deleted at that point and no longer pass a claim edit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Current codes carry a laterality digit and then a seventh character for the encounter. S02.30X- is the unspecified side, S02.31X- is the right, and S02.32X- is the left.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.31XA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of orbital floor, right side, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The usual pairing for a right-sided repair<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.32XA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of orbital floor, left side, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The usual pairing for a left-sided repair<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.31XB \/ S02.32XB<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of orbital floor, right or left side, initial encounter for open fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when the record classifies the fracture as open<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.31XD \/ S02.32XD<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of orbital floor, right or left side, subsequent encounter with routine healing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Post-operative follow-up inside the global period<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.30XA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of orbital floor, unspecified side, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Avoid it when the operative note names the side<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.831A \/ S02.832A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of medial orbital wall, right or left side, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A separate code family. Add it when medial wall involvement is documented alongside the floor fracture.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">H53.2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Diplopia<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Secondary diagnosis that supports medical necessity for repair<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">H05.401 \/ H05.402<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified enophthalmos, right or left eye<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Secondary diagnosis. Use H05.409 only when the eye is not documented.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Two errors account for most diagnosis-side rejections on these claims. The first is a deleted S02.3XXA code copied from an old superbill or an outdated coding article. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The second is a seventh character that does not match the visit, such as \u00ab\u00a0D\u00a0\u00bb on the initial surgical claim. Fracture codes across ICD-10 follow the same convention, as <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s42302k\/\">S42.302K<\/a> shows.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Medial orbital wall fracture is worth its own mention. It is not a variant of the floor code, and S02.31XA does not mean medial wall. That fracture belongs to S02.83-, and mislabeling it is a common source of confusion in orbital trauma coding.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Payer policy varies on top of all this. Some Medicare Administrative Contractors publish Local Coverage Determinations naming which diagnosis codes they accept for orbital fracture repair. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Check the applicable LCD before submitting, and see <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s02121b\/\">ICD-10 code S02.32XB<\/a> for how the laterality and encounter characters work on a single orbital floor code.<\/p>\n\n\n\n<h2 id=\"h-applicable-modifiers-for-cpt-code-21387\" class=\"wp-block-heading\">Applicable modifiers for CPT code 21387<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier selection for CPT 21387 depends on payer rules and the operative scenario. Bilateral blowout fracture repair in one session is uncommon, but it does happen. Verify bilateral policy with the applicable MAC first, because contractors differ on modifier 50 versus separate LT and RT lines.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use with CPT 21387<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Repair of the left orbital floor. Many MACs prefer this over modifier 50.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Repair of the right orbital floor<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral repair in the same session. Verify your MAC&rsquo;s preference first.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">51<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple procedures<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21387 performed alongside another distinct procedure in the same session<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A separate, distinct procedure that an NCCI edit would otherwise bundle<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Increased procedural services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Work well beyond the 21387 baseline. It needs an operative narrative explaining why.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">78<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unplanned return to the operating room<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Return to the OR for a related complication inside the global period<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">79<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unrelated procedure during the global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unrelated surgery performed inside the existing 90-day global period<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier 62 deserves a note of its own. Some combined repairs are staffed by two surgeons, with an ENT surgeon taking the transantral route and an oculoplastic surgeon the periorbital one. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Where both act as co-surgeons on the same 21387 line, each reports the code with modifier 62. Check the CMS co-surgeon indicator for the code before you plan the claim that way.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Check your MAC&rsquo;s bilateral modifier policy before submitting modifier 50 with CPT 21387. Several MACs require separate line items with LT and RT modifiers instead of a single line with modifier 50. Submitting the wrong format triggers an automatic denial and delays payment by weeks.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-medicare-reimbursement-and-fee-schedule-for-cpt-code-21387\" class=\"wp-block-heading\">Medicare reimbursement and fee schedule for CPT code 21387<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare pays CPT 21387 from the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Medicare Physician Fee Schedule<\/a>, which updates every January 1. The figures below reflect recently published national values. Treat them as a planning baseline, not a quote.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Value<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">9.86<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgeon effort, skill, and intraoperative judgment across both approaches<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice expense RVU<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">9.33<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility and non-facility rates differ. Most 21387 cases bill at the facility rate.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">1.83<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Specialty-specific liability component<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">21.02<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The figure the annual conversion factor is applied to<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">090 days<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Routine post-operative visits are included in the payment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare national average payment<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">About $700<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Professional fee only. Verify the current year through the CMS Look-Up Tool.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Two things move that number. The conversion factor changes every year, and Geographic Practice Cost Indices adjust each RVU component by locality. A surgeon in Manhattan and one in rural Kansas will not see the same payment for the same operation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Because 21387 is the combined-approach code, it carries more work value than the single-approach codes around it. That is the practical reason payers scrutinize the approach documentation on these claims. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pull current values from the CMS Look-Up Tool before you set contracted rates, and check the payment rules in our <a href=\"https:\/\/pabau.com\/blog\/medicare-billing\/\">Medicare billing<\/a> guide.<\/p>\n\n\n\n<h2 id=\"h-documentation-requirements-for-cpt-code-21387\" class=\"wp-block-heading\">Documentation requirements for CPT code 21387<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A clean CPT 21387 claim rests on four elements in the operative note. Miss any one of them and a payer has grounds to deny on medical necessity or code specificity.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Both access routes, named:<\/strong> state the periorbital incision by type, transconjunctival or subciliary, and state the transantral antrostomy separately. This is what separates 21387 from 21386 and 21385.<\/li>\n\n\n\n<li><strong>Fracture confirmation:<\/strong> record the CT findings for the orbital floor defect and the clinical correlation, such as diplopia, enophthalmos, or restricted extraocular movement.<\/li>\n\n\n\n<li><strong>Reduction of herniated tissue:<\/strong> describe the orbital fat or muscle that was released and returned to the orbit. This supports the need for open surgery.<\/li>\n\n\n\n<li><strong>What was placed, if anything:<\/strong> note any implant or graft. It does not change the 21387 descriptor, but it decides whether 21390 or 21395 is the better fit.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Laterality belongs in the note too. The side has to agree across the operative report, the diagnosis code, and any LT or RT modifier on the claim line.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices running a <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">plastic surgery EMR<\/a> can build these four checkpoints in as structured fields, so they are captured before the note is signed. The same <a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\">medical forms management<\/a> discipline that works for consents applies here. A standard structure produces audit-ready records.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21387\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Structured forms let a surgical team record each access route as a required field, so the approach detail behind a 21387 claim is never missing.<\/em><\/figcaption><\/figure>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Add a two-line approach statement to your pre-closure checklist: periorbital incision type, and transantral access yes or no. A coder should never have to call the surgeon to find out how many windows were opened. Ten seconds at closure saves a month of appeal.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-common-billing-errors-and-claim-denials\" class=\"wp-block-heading\">Common billing errors and claim denials<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">These are the failure patterns that show up when a 21387 claim reaches post-payment review. Most of them are settled long before submission, in the operative note.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Coding from the implant myth:<\/strong> choosing 21387 because no implant was placed. Implant status is irrelevant to this code, and a single-approach repair belongs on 21386.<\/li>\n\n\n\n<li><strong>Unbundling the approaches:<\/strong> billing 21385 and 21386 on the same claim instead of the single combined code.<\/li>\n\n\n\n<li><strong>A deleted diagnosis code:<\/strong> submitting S02.3XXA, S02.3XXB, or S02.3XXD, which have not been valid since October 1, 2016.<\/li>\n\n\n\n<li><strong>A mislabeled medial wall code:<\/strong> treating S02.31XA as a medial orbital wall fracture. It is the right-sided orbital floor code, and the medial wall lives at S02.83-.<\/li>\n\n\n\n<li><strong>The wrong seventh character:<\/strong> using \u00ab\u00a0D\u00a0\u00bb or \u00ab\u00a0S\u00a0\u00bb on the initial surgical claim.<\/li>\n\n\n\n<li><strong>A vague approach description:<\/strong> an operative note that says the floor was exposed, without naming the incisions.<\/li>\n\n\n\n<li><strong>Global period violations:<\/strong> billing a related post-operative service inside the 90-day window with no modifier.<\/li>\n\n\n\n<li><strong>A missing narrative for -22:<\/strong> appending the modifier without explaining what made the case harder than the 21387 baseline.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Coding guidance from the <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC code range lookup<\/a> also carries a warning about concurrent procedures. Do not report the 21385 to 21395 series alongside a separately reportable procedure unless distinct documentation supports it. Review NCCI edits before pairing 21387 with other facial fracture codes such as <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21452\/\">CPT code 21452<\/a>.<\/p>\n\n\n\n<h2 id=\"h-billing-21387-in-asc-vs-hospital-settings\" class=\"wp-block-heading\">Billing 21387 in ASC vs hospital settings<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21387 is performed in hospital and ambulatory surgical center settings alike. The billing mechanics differ by setting, and the split between the professional and facility fee is where claims go wrong.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In a hospital, the surgeon bills the professional fee under the MPFS. The hospital bills the facility fee separately under the Hospital Outpatient Prospective Payment System, using an Ambulatory Payment Classification rate. The surgeon does not bill the facility component at all.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In an ASC, the surgeon again bills the professional fee under the MPFS. The ASC bills its facility fee under the CMS ASC payment system. ASC facility rates run lower than HOPPS rates, though the setting usually carries lower overhead for the practice.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Billing element<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Hospital outpatient<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ASC<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Surgeon fee<\/td>\n<td style=\"padding:12px 16px;color:#374151\">MPFS (professional)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">MPFS (professional)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Facility fee<\/td>\n<td style=\"padding:12px 16px;color:#374151\">HOPPS APC rate, billed by the hospital<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS ASC rate, billed by the ASC<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice expense RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility rate (lower)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility rate (lower)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Place of service code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">22 (outpatient hospital)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">24 (ambulatory surgical center)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period applies<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes, 90 days<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes, 90 days<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The place of service code has to match where the surgery actually happened. Submitting POS 22 for an ASC case, or the reverse, applies the wrong practice expense RVU and triggers a claim edit. Practices weighing the two settings can start with our guide to opening a <a href=\"https:\/\/pabau.com\/blog\/opening-a-cosmetic-surgery-clinic\/\">cosmetic surgery practice<\/a>.<\/p>\n\n\n\n<h2 id=\"h-anesthesia-codes-paired-with-cpt-21387\" class=\"wp-block-heading\">Anesthesia codes paired with CPT 21387<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A combined orbital floor repair is done under general anesthesia. The anesthesia provider bills from the 00100 to 01999 range, not from 21387. The surgeon&rsquo;s billing team does not submit that code.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Anesthesia CPT<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Applicability<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">00190<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for procedures on facial bones or skull, not otherwise specified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The usual pairing for 21387. Confirm it with the anesthesia group.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">00192<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for procedures on facial bones or skull, radical surgery<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Carries more base units. It applies only where the record documents radical surgery.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The two records still need to tell the same story. If the anesthesia record describes a simpler operation than the surgical note, a payer can question both claims. That risk rises with 21387, because the combined approach is exactly what justifies its higher work value.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-keeps-21387-claims-matched-to-the-operative-note\" class=\"wp-block-heading\">How Pabau keeps 21387 claims matched to the operative note<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In most surgical practices the operative note lives in one system and the claim is built in another. Someone reads the note, retypes the codes into a billing tool, and hopes the two still agree at audit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps both in one record. The patient&rsquo;s insurer and policy sit on their chart, so every invoice routes to the right payer without re-keying. <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">Claims management<\/a> submits electronically, tracks each claim through submitted, processing, paid, or error, and posts the remittance back against the invoice.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Validation runs before anything leaves the practice. A missing membership number or authorization code stops the send, rather than coming back weeks later as a rejection.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Structured forms hold the detail a 21387 note needs: each incision, the laterality, and whether an implant or graft was placed. Your team spends its time on the surgery schedule instead of reworking denials.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21387\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automated claims submission sends each surgical line straight to the payer, so a 21387 claim leaves with the codes recorded on the note.<\/em><\/figcaption><\/figure>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Keep every surgical claim tied to its clinical record                <\/h3>\n\n                <p class=\"description\">\n                    Pabau brings claims, invoices, and clinical records into one system. Submit electronically, watch every claim&rsquo;s status, and fix missing details before a payer rejects them.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims dashboard for surgical billing\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21387 is the combined-approach code, and nothing more. A reviewer opens the operative note looking for two access routes, and either finds them named or does not. Implant status has no bearing on that decision.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So write the note for that reader. Name the periorbital incision, name the antrostomy, name the side, and pair the claim with a current laterality-specific diagnosis code. Do that and 21387 stops being a code you defend after payment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Fixing this while the note is still open costs a few extra lines. Fixing it at appeal costs weeks. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau keeps surgical claims and clinical records in step.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Reconstructing the orbital wall rather than reducing a fracture?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21184\/\">CPT code 21184<\/a> walks through orbital wall reconstruction billing and its documentation.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding another facial fracture repair?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21365\/\">CPT code 21365<\/a> covers complicated malar fractures, their modifiers, and their reimbursement.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing a midface fracture repair?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21422\/\">CPT code 21422<\/a> covers open treatment of a palatal or maxillary fracture, with its modifiers and documentation.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786714633179\"><h3 class=\"schema-faq-question\">What does CPT code 21387 describe?<\/h3> <p class=\"schema-faq-answer\">CPT code 21387 describes open treatment of an orbital floor blowout fracture using a combined approach. The surgeon reaches the fracture through both periorbital and transantral access in the same operative session. The descriptor says nothing about implants. A repair done through a periorbital incision alone codes to 21386 instead.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714633180\"><h3 class=\"schema-faq-question\">What is the difference between CPT codes 21386 and 21387?<\/h3> <p class=\"schema-faq-answer\">The difference is the number of access routes, not implant status. CPT 21386 covers a repair performed entirely through a periorbital incision, such as a transconjunctival or subciliary approach. CPT 21387 applies when that periorbital access is combined with a transantral, or Caldwell-Luc, route through the maxillary sinus. The operative note has to name every incision for either code to hold.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714633186\"><h3 class=\"schema-faq-question\">What counts as a combined approach under CPT 21387?<\/h3> <p class=\"schema-faq-answer\">A combined approach means the surgeon opens more than one route to the orbital floor during the same session. In practice that is a periorbital incision paired with a transantral window into the maxillary sinus. Both routes belong on the single 21387 line. Billing 21385 and 21386 together for one repair is unbundling, and payers deny it.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714633185\"><h3 class=\"schema-faq-question\">How does CPT 21387 differ from CPT 21390 and 21395?<\/h3> <p class=\"schema-faq-answer\">CPT 21390 covers a periorbital-approach repair in which the surgeon places an alloplastic or other implant. CPT 21395 covers a periorbital-approach repair with a bone graft, and the descriptor already includes obtaining that graft. CPT 21387 turns on access route instead, so implant and graft status do not select it. There is no code for a combined approach with an implant, so confirm the payer&rsquo;s expectation before submitting that case.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714633183\"><h3 class=\"schema-faq-question\">Which ICD-10 diagnosis codes are used with CPT 21387?<\/h3> <p class=\"schema-faq-answer\">Use a laterality-specific orbital floor fracture code: S02.30X- for an unspecified side, S02.31X- for the right, and S02.32X- for the left. Add the seventh character for the encounter, so an initial closed fracture on the right reads S02.31XA. The older S02.3XXA, S02.3XXB, and S02.3XXD codes were deleted on October 1, 2016. Medial orbital wall fracture is a separate family at S02.83-, not a variant of the floor code.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714633181\"><h3 class=\"schema-faq-question\">What modifiers apply to CPT code 21387?<\/h3> <p class=\"schema-faq-answer\">Common modifiers for CPT 21387 are LT, RT, 50, 51, 59, 22, 78, and 79. Use LT or RT to state the side, and 50 for a bilateral repair, though many contractors want separate LT and RT lines instead. Modifier 22 needs an operative narrative explaining the extra work. Where an ENT surgeon and an oculoplastic surgeon split the two approaches as co-surgeons, each may report the code with modifier 62.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714633182\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for CPT 21387?<\/h3> <p class=\"schema-faq-answer\">CPT 21387 carries roughly 9.86 work RVUs and about 21.02 total RVUs, with a 90-day global period. Recent national values put the professional fee near $700. Your actual payment depends on the annual conversion factor and your locality&rsquo;s geographic adjustment. Check the CMS Physician Fee Schedule Look-Up Tool for the current year before you set contracted rates.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT 21387 turns on access route, not implant status. Get the descriptor, ICD-10 pairings, modifiers, and RVUs for a combined repair.<\/p>\n","protected":false},"author":83,"featured_media":180637,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"92","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[1543,1162,1602,2775,1236,1646],"class_list":["post-180639","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-clinical-documentation","tag-cpt-codes","tag-cpt-modifiers","tag-fracture-management","tag-medicare-reimbursement","tag-ophthalmology-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT code 21387: Combined approach, modifiers, and RVUs<\/title>\n<meta name=\"description\" content=\"CPT 21387 turns on access route, not implant status. Get the descriptor, ICD-10 pairings, modifiers, and RVUs for a combined repair.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT code 21387: Combined approach, modifiers, and RVUs\" \/>\n<meta property=\"og:description\" content=\"CPT 21387 turns on access route, not implant status. 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A repair done through a periorbital incision alone codes to 21386 instead.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21387\\\/#faq-question-1786714633180\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21387\\\/#faq-question-1786714633180\",\"name\":\"What is the difference between CPT codes 21386 and 21387?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The difference is the number of access routes, not implant status. CPT 21386 covers a repair performed entirely through a periorbital incision, such as a transconjunctival or subciliary approach. CPT 21387 applies when that periorbital access is combined with a transantral, or Caldwell-Luc, route through the maxillary sinus. The operative note has to name every incision for either code to hold.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21387\\\/#faq-question-1786714633186\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21387\\\/#faq-question-1786714633186\",\"name\":\"What counts as a combined approach under CPT 21387?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"A combined approach means the surgeon opens more than one route to the orbital floor during the same session. In practice that is a periorbital incision paired with a transantral window into the maxillary sinus. Both routes belong on the single 21387 line. Billing 21385 and 21386 together for one repair is unbundling, and payers deny it.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21387\\\/#faq-question-1786714633185\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21387\\\/#faq-question-1786714633185\",\"name\":\"How does CPT 21387 differ from CPT 21390 and 21395?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 21390 covers a periorbital-approach repair in which the surgeon places an alloplastic or other implant. CPT 21395 covers a periorbital-approach repair with a bone graft, and the descriptor already includes obtaining that graft. CPT 21387 turns on access route instead, so implant and graft status do not select it. There is no code for a combined approach with an implant, so confirm the payer's expectation before submitting that case.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21387\\\/#faq-question-1786714633183\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21387\\\/#faq-question-1786714633183\",\"name\":\"Which ICD-10 diagnosis codes are used with CPT 21387?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Use a laterality-specific orbital floor fracture code: S02.30X- for an unspecified side, S02.31X- for the right, and S02.32X- for the left. Add the seventh character for the encounter, so an initial closed fracture on the right reads S02.31XA. The older S02.3XXA, S02.3XXB, and S02.3XXD codes were deleted on October 1, 2016. Medial orbital wall fracture is a separate family at S02.83-, not a variant of the floor code.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21387\\\/#faq-question-1786714633181\",\"position\":6,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21387\\\/#faq-question-1786714633181\",\"name\":\"What modifiers apply to CPT code 21387?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Common modifiers for CPT 21387 are LT, RT, 50, 51, 59, 22, 78, and 79. Use LT or RT to state the side, and 50 for a bilateral repair, though many contractors want separate LT and RT lines instead. Modifier 22 needs an operative narrative explaining the extra work. 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She enjoys breaking down complex topics into clear, accessible content and has a soft spot for the often-overlooked aspects of clinic life. When she's not writing, she's exploring cafes, walking her dog, or spending time with friends and family.","url":"https:\/\/pabau.com\/fr\/blog\/author\/anja-dodevska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633179","position":1,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633179","name":"What does CPT code 21387 describe?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 21387 describes open treatment of an orbital floor blowout fracture using a combined approach. The surgeon reaches the fracture through both periorbital and transantral access in the same operative session. The descriptor says nothing about implants. A repair done through a periorbital incision alone codes to 21386 instead.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633180","position":2,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633180","name":"What is the difference between CPT codes 21386 and 21387?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The difference is the number of access routes, not implant status. CPT 21386 covers a repair performed entirely through a periorbital incision, such as a transconjunctival or subciliary approach. CPT 21387 applies when that periorbital access is combined with a transantral, or Caldwell-Luc, route through the maxillary sinus. The operative note has to name every incision for either code to hold.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633186","position":3,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633186","name":"What counts as a combined approach under CPT 21387?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"A combined approach means the surgeon opens more than one route to the orbital floor during the same session. In practice that is a periorbital incision paired with a transantral window into the maxillary sinus. Both routes belong on the single 21387 line. Billing 21385 and 21386 together for one repair is unbundling, and payers deny it.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633185","position":4,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633185","name":"How does CPT 21387 differ from CPT 21390 and 21395?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21390 covers a periorbital-approach repair in which the surgeon places an alloplastic or other implant. CPT 21395 covers a periorbital-approach repair with a bone graft, and the descriptor already includes obtaining that graft. CPT 21387 turns on access route instead, so implant and graft status do not select it. There is no code for a combined approach with an implant, so confirm the payer's expectation before submitting that case.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633183","position":5,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633183","name":"Which ICD-10 diagnosis codes are used with CPT 21387?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Use a laterality-specific orbital floor fracture code: S02.30X- for an unspecified side, S02.31X- for the right, and S02.32X- for the left. Add the seventh character for the encounter, so an initial closed fracture on the right reads S02.31XA. The older S02.3XXA, S02.3XXB, and S02.3XXD codes were deleted on October 1, 2016. Medial orbital wall fracture is a separate family at S02.83-, not a variant of the floor code.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633181","position":6,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633181","name":"What modifiers apply to CPT code 21387?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Common modifiers for CPT 21387 are LT, RT, 50, 51, 59, 22, 78, and 79. Use LT or RT to state the side, and 50 for a bilateral repair, though many contractors want separate LT and RT lines instead. Modifier 22 needs an operative narrative explaining the extra work. Where an ENT surgeon and an oculoplastic surgeon split the two approaches as co-surgeons, each may report the code with modifier 62.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633182","position":7,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21387\/#faq-question-1786714633182","name":"What is the Medicare reimbursement rate for CPT 21387?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21387 carries roughly 9.86 work RVUs and about 21.02 total RVUs, with a 90-day global period. Recent national values put the professional fee near $700. Your actual payment depends on the annual conversion factor and your locality's geographic adjustment. Check the CMS Physician Fee Schedule Look-Up Tool for the current year before you set contracted rates.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"}]}},"yoast":{"focus_keyword":"CPT code 21387","seo_title":"CPT code 21387: Combined approach, modifiers, and RVUs","meta_description":"CPT 21387 turns on access route, not implant status. Get the descriptor, ICD-10 pairings, modifiers, and RVUs for a combined repair.","content_score":"30","is_cornerstone":"","related_keyphrases":[{"keyword":"orbital floor blowout fracture CPT","score":67},{"keyword":"facial fracture CPT codes","score":61},{"keyword":"blowout fracture ICD-10 code","score":56}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts\/180639","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/users\/83"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/comments?post=180639"}],"version-history":[{"count":4,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts\/180639\/revisions"}],"predecessor-version":[{"id":181154,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts\/180639\/revisions\/181154"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/media\/180637"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/media?parent=180639"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/categories?post=180639"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/tags?post=180639"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}