CPT® Code 21742

1. Indications

The procedure coded as CPT® 21742 is indicated for patients presenting with pectus excavatum or pectus carinatum, which are conditions characterized by abnormal chest wall deformities. These deformities can lead to various symptoms and complications, including:

• Pectus Excavatum - A condition where the sternum is sunken into the chest, potentially causing respiratory difficulties, reduced exercise tolerance, and psychological distress due to cosmetic concerns.
• Pectus Carinatum - A condition where the sternum protrudes outward, which may also lead to similar respiratory issues and self-esteem challenges.

2. Procedure

The Nuss procedure, as described by CPT® 21742, involves several key steps that are crucial for the successful correction of the chest wall deformity. The procedural steps include:

• Step 1: Anesthesia Administration - The patient is placed under general anesthesia to ensure comfort and immobility during the surgical procedure.
• Step 2: Incision Creation - Two lateral incisions are made on either side of the chest, allowing access to the area beneath the sternum without the need for thoracoscopy.
• Step 3: Bar Insertion - A specially designed curved steel bar is carefully inserted under the sternum through the incisions. This bar is uniquely shaped for each patient to effectively address the specific chest wall deformity.
• Step 4: Bar Positioning - The bar is positioned to elevate the depressed area of the chest, effectively correcting the deformity. The surgeon ensures that the bar is properly aligned for optimal results.
• Step 5: Stabilization - The bar is fixed to the ribs on either side to maintain its position and provide stability. In some cases, a small steel, grooved plate may be used at the end of the bar to enhance fixation to the ribcage.
• Step 6: Closure of Incisions - After ensuring that the bar is securely in place, the incisions are closed and dressed appropriately to promote healing and minimize the risk of infection.

3. Post-Procedure

Following the Nuss procedure coded as CPT® 21742, patients typically require careful monitoring and post-operative care to ensure a smooth recovery. Expected post-procedure care includes pain management, monitoring for any signs of complications, and follow-up appointments to assess the positioning of the bar and overall healing. Patients may experience discomfort and will be advised on activity restrictions to facilitate proper healing. The bar is usually left in place for a specified duration, after which it may be removed in a subsequent procedure, depending on the individual patient's needs and the surgeon's recommendations.