Presence of Additional Rhinoplasty Codes in Primary Cleft Lip Repair: A National Review of 8836 Cases

ObjectiveTo evaluate national billing patterns for adjunctive rhinoplasty during primary cleft lip repair and assess associated operative characteristics.DesignRetrospective database review.SettingAmerican College of Surgeons Pediatric National Surgical Quality Improvement Program, 2016-2021.Patients, ParticipantsPatients undergoing primary cleft lip repair identified using current procedural terminology (CPT) codes 40700-40702, stratified by use of additional rhinoplasty codes (30400-30462).InterventionsPrimary cleft lip repair with or without adjunctive rhinoplasty coding.Main Outcome Measure(s)Use of adjunctive rhinoplasty codes, operative and anesthesia times, surgeon specialty, patient characteristics, and temporal trends in coding.ResultsAmong 8836 patients, 32.9% (n = 2911) were billed adjunctive rhinoplasty codes, most commonly CPT 30460 (78.0%) and 30462 (16.2%). Cases billed with adjunct rhinoplasty codes were associated with longer operative (146.0 vs. 114.6 min; p < .001) and anesthesia times (208.8 vs. 172.4 min; p < .001), as well as a higher proportion of ASA class II patients (62.4% vs. 55.0%; p < .001). Plastic surgeons performed most primary cleft lip repairs (85%) and were more likely to bill adjunct rhinoplasty codes (p = .013).ConclusionsNearly one-third of primary cleft lip repairs include adjunctive rhinoplasty codes. Although comprehensive primary codes exist, differences in interpretation rather than evolving practice patterns may exist. Given the ongoing undervaluation of craniofacial procedures and limited coding mechanisms, clearer guidance is needed to better align billing with contemporary cleft surgical practice.