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The procedure described by CPT® Code 21602 involves the excision of a tumor located in the chest wall, which is the structure composed of bones and muscles that encase the chest cavity, safeguarding vital organs such as the lungs, heart, and major blood vessels. Tumors in this area can be classified as benign or malignant, with benign tumors typically not invading surrounding tissues or spreading to other parts of the body, although they may require removal due to their size or location. In contrast, malignant tumors have the potential to invade adjacent tissues or metastasize to distant organs. The distinction between primary and secondary tumors is also important; primary tumors originate within the chest wall itself, while secondary tumors arise from other locations in the body and subsequently spread to the chest wall. In the context of CPT® Code 21602, the procedure entails not only the excision of the tumor but also the reconstruction of the chest wall following the removal. This reconstruction is crucial for restoring the structural integrity of the chest wall after the tumor and affected ribs have been excised. The specific approach to reconstruction may vary based on the size and location of the defect created by the tumor removal. Various materials, including alloplastic options like stainless steel and titanium, as well as biological grafts such as ribs or bone grafts, may be utilized to repair the skeletal defects. Additionally, soft tissue defects can be addressed using muscle flaps from the latissimus dorsi, pectoralis major, or abdominus rectus, among other techniques. This comprehensive approach ensures that both the tumor is effectively removed and the chest wall is reconstructed to maintain its function and appearance.
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The procedure associated with CPT® Code 21602 is indicated for the excision of tumors located in the chest wall. The specific indications for this procedure include:
The procedure for CPT® Code 21602 involves several critical steps to ensure the effective removal of the tumor and subsequent reconstruction of the chest wall. The steps are as follows:
Following the procedure, patients typically require monitoring for any complications related to the surgery. Post-operative care may include pain management, wound care, and monitoring for signs of infection. The recovery process will vary depending on the extent of the surgery and the individual patient's health status. Patients may also need follow-up appointments to assess the healing of the surgical site and the effectiveness of the reconstruction. Rehabilitation may be necessary to restore function and strength in the chest wall area, particularly if significant muscle or structural support was involved in the reconstruction.
| Short Descr | EXC CH WAL TUM W/O LYMPHADEC | Medium Descr | EXCISION CH WAL TUM W/RIB W/O MEDSTNL LYMPHADEC | Long Descr | Excision of chest wall tumor involving rib(s), with plastic reconstruction; without mediastinal lymphadenectomy | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2020-01-01 | Added | Code added. |
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