{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T01:58:55Z","timestamp":1794275935430,"version":"4.9.0"},"reference-count":22,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:00:00Z","timestamp":1746662400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Accurate current PROCEDURAL TERMINOLOGY (CPT) coding is essential to healthcare costs and fair reimbursement. In craniofacial (CF) surgery, specific codes for procedures like mandibular distraction and cranial remodeling are lacking, leading to unclear standards that may undervalue complex techniques. This study hypothesizes variability in billing exists and aims to characterize these trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design &amp; Setting<\/jats:title>\n                    <jats:p>A 21-question survey was distributed via email.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Members of the American Society of Maxillofacial Surgeons and American Society of Craniofacial Surgeons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes Measures<\/jats:title>\n                    <jats:p>Respondents selected CPT codes for six clinical vignettes: mandibular distraction (MDO), fronto-orbital advancement (FOA), posterior vault distraction (PVD) &amp; reconstruction (PVR), cranial springs (CS), and le fort III distraction (LFD). Details of training and practice environment were recorded. Chi-squared analysis compared trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 338 recipients, 36 completed responses (10.7%). For MDO, 60.6% used orthopedic fixation codes (20690\/92) with mandibular osteotomy. Temporalis flaps (15733) were billed separately by 23.5% when performed for FOA. Half of respondents billed for each distractor in MDO and PVD. Billing additional codes was more common in academia, fellowship-trained, integrated trained, and high-volume CF practices (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      -values\u2009=\u2009.04, .001, .034, .036). Neurosurgical craniectomy codes were more common than cranioplasty codes for PVR, CS, and PVD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study reveals inconsistent billing practices among CF surgeons driven by insufficient CPT codes. Variable approaches to billing, influenced by training and practice backgrounds, risks undervaluation of CF services. Multidisciplinary efforts are needed to create a more robust billing system to ensure fair compensation and equitable delivery of CF care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656251338640","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T03:06:28Z","timestamp":1746673588000},"page":"1515-1520","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Navigating Coding Challenges in Craniofacial Surgery: A National Survey Analysis on CPT Variability"],"prefix":"10.1177","volume":"63","author":[{"given":"Ashlie A.","family":"Elver","sequence":"first","affiliation":[{"name":"University of Mississippi Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clay","family":"Thames","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy K.","family":"Perry","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura S.","family":"Humphries","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8332-2280","authenticated-orcid":false,"given":"Ian C.","family":"Hoppe","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"American Medical Association Current Procedural Terminology Platform. Available at: https:\/\/www.ama-assn.org\/topics\/cpt-codes. Date accessed: November 19 2024."},{"key":"e_1_3_2_3_2","unstructured":"Centers for Medicare & Medicaid Services Relative Value Files. Available at: https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/physician\/pfs-relative-value-files. Date accessed: November 19 2024."},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198809293191305"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hjdsi.2014.11.004"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000009922"},{"key":"e_1_3_2_7_2","unstructured":"American Medical Association. CPT\u00ae Editorial panel meeting process. Available at: https:\/\/www.ama-assn.org\/about\/cpt-editorial-panel\/cpt-editorial-panel-meeting-process. Accessed December 7 2024."},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2013.0483"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000003666"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000006362"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000003667"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000304603.19047.0b"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000009922"},{"issue":"3","key":"e_1_3_2_14_2","first-page":"388","article-title":"New 5-D coding system for categorization of plastic surgery conditions","volume":"8","author":"Gupta S","year":"2019","unstructured":"Gupta S, Chittoria RK, Chavan V, Aggarwal A, Reddy CL, Mohan PB, Shijina K, Pathan I. New 5-D coding system for categorization of plastic surgery conditions. PubMed. 2019;8(3):388\u2013393. doi:https:\/\/doi.org\/10.29252\/wjps.8.3.388","journal-title":"PubMed"},{"key":"e_1_3_2_15_2","unstructured":"The National Correct Coding Initiative (NCCI). Centers for medicare & medicaid services. Available at: https:\/\/www.cms.gov\/national-correct-coding-initiative-ncci#:\u223c:text=The%20Centers%20for%20Medicare%20%26%20Medicaid Part%20B%20and%20Medicaid%20claims. Date accessed: November 19 2024."},{"key":"e_1_3_2_16_2","unstructured":"General correct coding policies for medicare national correct coding initiative policy manual last updated 1\/1\/2024. Available at: https:\/\/www.cms.gov\/files\/document\/medicare-ncci-policy-manual-2024-chapter-1.pdf. Date accessed: November 19 2024."},{"key":"e_1_3_2_17_2","article-title":"Recognizing Variations in Primary Palatoplasty Billing: A Review of 9,827 Cases","author":"Elver AA","unstructured":"Elver AA, Zhang WQ, Perry NK, Lewis J, Humphries LS, Hoppe IC. Recognizing Variations in Primary Palatoplasty Billing: A Review of 9,827 Cases. Cleft Palate Craniofac J. Epub ahead of print 2024 December. PMID: 39668664.","journal-title":"Cleft Palate Craniofac J."},{"key":"e_1_3_2_18_2","volume-title":"CPT 2024: Current Procedural Terminology","year":"2023","unstructured":"CPT 2024: Current Procedural Terminology. Chicago, IL: American Medical Association; 2023. Available at: https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-books-and-products."},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000010697"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000010329"},{"key":"e_1_3_2_21_2","volume-title":"CPT Professional Edition 2024","author":"American Medical Association","unstructured":"American Medical Association. CPT Professional Edition 2024. Chicago, IL: AMA Publishing. For online information about Modifier-22, See: https:\/\/www.ama-assn.org."},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2020.03.002"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31825c0871"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656251338640","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10556656251338640","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656251338640","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T17:48:37Z","timestamp":1778867317000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10556656251338640"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,8]]},"references-count":22,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1177\/10556656251338640"],"URL":"https:\/\/doi.org\/10.1177\/10556656251338640","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,8]]}}}