Billing Practices in Pediatric Fronto-Orbital Advancement Surgeries: Review of a National Billing Database

Fronto-orbital advancement (FOA) for craniosynostosis is the standard treatment for patients with anterior cranial vault differences. Despite its widespread use, national billing practices for FOA have not been described. This study analyzes billing codes from a national multicenter claims database to evaluate variations in billing for FOA, aiming to inform standardization efforts.

We performed a retrospective study using PearlDiver, a national deidentified aggregate claims database covering over 100 million patients in the United States. Patients aged 0 to 16 years who had undergone FOA between 2007 and 2015 were included. CPT codes used to characterize various craniosynostosis and cranioplasty techniques, such as muscle flap, craniectomy for single or multiple suture craniosynostosis, bone flap, craniectomy, and other fronto-orbital contouring and bone graft interventions were included. Descriptive statistics were conducted using PearlDiver and Microsoft Excel.

A total of 2026 patients met the inclusion criteria. In addition to billing for the index FOA procedure (CPT 21175), other codes billed in order of decreasing frequency were extensive craniectomy for multiple cranial suture craniosynostosis requiring multiple osteotomies and bone autografts (44.6%), craniectomy with bifrontal bone flap (37.1%), and muscle advancement flap to the orbital bandeau (7.3%). Less frequently billed codes included extensive craniectomy for multisuture craniosynostosis not requiring bone grafts (4.5%), and forehead reconstruction with autografts (3.95%) or allografts (1.28%).

Our study characterizes current national trends in fronto-orbital advancement billing practices. Our findings emphasize the need for standardization to ensure equitable compensation that reflects the complexity of FOA procedures.