Open surgical treatment of a nasoethmoid fracture with internal fixation

Verified May 8, 2026 · 5 sources ↓

Medicare: $700.08
Work RVU: 8.29
Global, days: 90
Region: Other

Drawn from CMSCgsmedicareEmednyAAOS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Preoperative imaging (CT facial bones) confirming nasoethmoid fracture pattern and displacement
Operative note specifying open approach, structures exposed, and method of fixation (plates, screws, transnasal wires)
Documentation of intercanthal distance measurement and reduction achieved — critical for medial canthal tendon involvement
Identification of any concomitant injuries addressed (orbital wall, frontal sinus, NOE complex bilaterality) with separate descriptions of each repair
Surgeon attestation of medical necessity for open over closed approach, citing fracture displacement, comminution, or failed closed reduction

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 21339 describes open repair of a nasoethmoid fracture with fixation. The nasoethmoid complex — the junction of the nasal bones, ethmoid, and medial orbital walls — is notoriously difficult to restore given the forces required to fracture it and the precision needed to re-establish intercanthal distance and nasal projection. Open access is required when closed reduction cannot achieve or maintain adequate reduction, or when comminution demands direct visualization and rigid fixation with plates, screws, or wires.

This code carries a 90-day global period. Routine post-op visits, wound checks, and hardware monitoring within that window are bundled — bill them separately only with modifier 24 (unrelated E/M) or 79 (unrelated procedure). The 90-day global also means the pre-operative visit the day before surgery is included unless the decision for surgery was made at that encounter, in which case modifier 57 applies to that E/M.

Nasoethmoid fractures frequently occur alongside other midface, orbital, or frontal sinus injuries. When separate, distinctly documented procedures are performed on anatomically distinct structures at the same operative session, modifier 59 or the appropriate X modifier can unlock separate payment — but the operative note must explicitly identify each injury and each repair as independent work, not just components of a single exposure.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (8.29) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.96) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.29
Practice expense RVU	11.46
Malpractice RVU	1.21
Total RVU	20.96
Medicare national rate	$700.08
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$700.08
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,025.62

Common denial reasons

The recurring reasons claims for CPT 21339 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Operative note fails to distinguish open fixation work from any concurrent closed or soft-tissue procedures, triggering bundling
Missing or inadequate CT imaging documentation in the record at time of audit
Modifier 59 or XS applied to same-session facial fracture codes without distinct procedure documentation supporting separate work
Global period billing conflict when post-op visits are submitted without modifier 24 or 79 within the 90-day window
Payer downcodes to a less complex facial fracture repair code when the operative note lacks specificity about the nasoethmoid complex and fixation method

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can 21339 be billed with orbital fracture repair codes on the same day?

Yes, if the nasoethmoid repair and the orbital repair are genuinely separate procedures with distinct documentation. Append modifier 51 to the lower-value code and modifier 59 or XS where NCCI edits are present. The operative note must describe each repair independently — shared exposure alone does not justify separate billing.

02What modifier applies when the decision for this surgery was made at the same-day E/M visit?

Modifier 57 on the E/M visit. The pre-operative evaluation is excluded from the global package when the decision for a major procedure (90-day global) is made at that encounter. Document the clinical decision-making that led to the surgical plan.

03Is 21339 appropriate for bilateral nasoethmoid fractures, and does modifier 50 apply?

Nasoethmoid fractures span the midline and are generally treated as a single repair regardless of bilateral involvement. Modifier 50 is not typically appropriate here. If truly separate, lateralized fixations are performed, document each distinctly and consult payer policy before appending RT/LT or 50.

04What ICD-10 codes are typically paired with 21339?

S02.2XXA (fracture of nasal bones, initial encounter) is the most common pairing, but nasoethmoid fractures may be coded more specifically with S02.8XXA (fractures of other specified skull and facial bones). Use the most specific code supported by imaging and operative findings. Initial encounter suffix (A) applies through active surgical treatment.

05If hardware removal is needed after the 90-day global, what code applies?

Hardware removal after the global period closes is separately billable. Use the appropriate facial hardware removal code with modifier 79 if the removal occurs during the global window due to an unrelated indication, or with modifier 78 if it is an unplanned return related to a complication of the original fixation.

06Does the site of service affect payment for 21339?

Yes. The HOPD and ASC payment rates differ significantly — see the Site of Service comparison table on this page. For Medicare, the physician's professional fee also differs between facility and non-facility settings based on practice expense RVUs, though this procedure is effectively always performed in a facility.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the approach, fixation hardware type and placement sites, intercanthal measurements pre- and post-reduction, and each anatomical structure individually addressed. This prevents the most common audit flag for 21339: an operative note that describes a single midface exposure without differentiating the nasoethmoid repair from any concurrent orbital or frontal sinus work, which invites bundling denials on multi-structure cases.

See how Mira captures CPT 21339 documentation