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The procedure described by CPT® Code 21230 involves the harvesting of autogenous rib cartilage for use in reconstructive surgery on the face, chin, nose, or ear. This type of graft utilizes the patient's own rib cartilage, typically sourced from the eighth or ninth rib, although the tenth rib may also be utilized if additional cartilage is necessary. The process begins with a surgical incision made over the targeted rib, followed by careful dissection to access the rib perichondrium. It is crucial to perform this dissection with precision, as the pleura, which is the membrane surrounding the lungs, can be closely adhered to the perichondrium. Once the rib cartilage is freed from the surrounding soft tissue, it is excised to create the graft. After harvesting the cartilage, the surgical site is inspected for any potential pleural leaks by instilling saline into the wound, which helps identify air bubbles that may indicate a tear in the pleura. If a tear is detected, it is repaired with sutures before the soft tissues are closed in layers. The harvested cartilage graft is then shaped and sized appropriately to reconstruct the specific deformity of the face, chin, nose, or ear, ensuring that the graft integrates well with the surrounding anatomical structures.
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The procedure associated with CPT® Code 21230 is indicated for various reconstructive needs involving the face, chin, nose, or ear. The specific indications include:
The procedure for harvesting rib cartilage as described in CPT® Code 21230 involves several critical steps:
Post-procedure care following the harvesting of rib cartilage involves monitoring the surgical site for signs of infection or complications. Patients may be advised to avoid strenuous activities that could stress the surgical area. Pain management is typically addressed with prescribed medications, and follow-up appointments are scheduled to assess healing and the integration of the graft. The expected recovery time may vary depending on the extent of the procedure and the individual patient's healing response. Proper care and adherence to post-operative instructions are essential for optimal outcomes.
| Short Descr | RIB CARTILAGE GRAFT | Medium Descr | GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR | Long Descr | Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 2 | CCS Clinical Classification | 164 - Other OR therapeutic procedures on musculoskeletal system |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary | SG | Ambulatory surgical center (asc) facility service |
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| Pre-1990 | Added | Code added. |
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