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The procedure described by CPT® Code 21603 involves the excision of a tumor located in the chest wall, which is the structural framework consisting 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. Conversely, 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 sites in the body and subsequently spread to the chest wall. In the context of CPT® Code 21603, the procedure entails not only the excision of the chest wall tumor but also the removal of mediastinal lymph nodes, which are critical for assessing the spread of malignancy. The surgical approach includes making an incision over the tumor, opening the chest cavity, and resecting the full thickness of the chest wall along with the adjacent pleura, ensuring a margin of healthy tissue is included. Additionally, the involved rib and at least one rib above and below the tumor site are excised. Following the tumor removal, the chest wall is reconstructed using various materials and techniques, which may include alloplastic materials or autologous grafts, depending on the specific requirements of the defect created by the excision. This comprehensive approach aims to ensure complete removal of the tumor while maintaining the structural integrity of the chest wall.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 21603 is indicated for the excision of tumors located in the chest wall, particularly when there is a need to remove mediastinal lymph nodes due to the potential spread of malignancy. The following conditions may warrant this procedure:
The procedure for CPT® Code 21603 involves several critical steps to ensure the effective excision of the tumor and reconstruction of the chest wall:
Post-procedure care following the excision of a chest wall tumor with mediastinal lymphadenectomy is critical for recovery. Patients may require monitoring for complications such as infection, bleeding, or respiratory issues due to the nature of the surgery. Pain management will be an essential component of post-operative care, and patients may be advised to limit physical activity during the initial recovery phase. Follow-up appointments will be necessary to assess healing, evaluate the surgical site, and discuss any further treatment options based on the pathology results of the excised tumor and lymph nodes. Additionally, rehabilitation may be recommended to restore strength and function to the chest wall and surrounding areas.
| Short Descr | EXC CH WAL TUM W/LYMPHADEC | Medium Descr | EXCISION CH WAL TUM W/RIB W/MEDSTNL LYMPHADEC | Long Descr | Excision of chest wall tumor involving rib(s), with plastic reconstruction; with 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). | 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. | 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). | 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 | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 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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