CPT® Code 21743

1. Indications

The procedure described by CPT® Code 21743 is indicated for patients diagnosed with pectus excavatum or pectus carinatum. These conditions are characterized by abnormal chest wall deformities that can lead to various complications, including cosmetic concerns, psychological distress, and potential respiratory difficulties. The Nuss procedure is typically recommended for individuals who exhibit significant deformities that may impact their quality of life or physical function.

• Pectus Excavatum A condition where the sternum is sunken into the chest, creating a depression that can affect heart and lung function.
• Pectus Carinatum A condition characterized by a protruding sternum, which can also lead to aesthetic concerns and potential respiratory issues.

2. Procedure

The Nuss procedure, as outlined in CPT® Code 21743, involves several critical steps to ensure effective correction of the chest wall deformity. Initially, the patient is placed under general anesthesia to ensure comfort and immobility during the surgery.

• Step 1: Incision Creation Two lateral incisions are made on either side of the chest. These incisions are strategically placed to allow access to the thoracic cavity while minimizing tissue trauma.
• Step 2: Thoracoscope Insertion A separate incision is made to introduce a thoracoscope, which provides direct visualization of the surgical area. This step is crucial for guiding the placement of the curved steel bar under the sternum.
• Step 3: Bar Insertion A custom-shaped curved steel bar is carefully inserted beneath the sternum. The curvature of the bar is tailored to the individual anatomy of the patient, ensuring optimal correction of the chest wall deformity.
• Step 4: Bar Stabilization Once the bar is positioned correctly, it is fixed to the ribs on either side to maintain its placement and provide the necessary support to elevate or depress the chest wall as required.
• Step 5: Closure of Incisions After the bar is secured, all incisions are meticulously closed and dressed. This step is essential for promoting healing and minimizing the risk of infection.
• Step 6: Optional Plate Placement In some cases, a small steel, grooved plate may be used at the end of the bar to enhance stability and fixation to the rib, further ensuring the success of the procedure.

3. Post-Procedure

Following the Nuss procedure, patients typically require monitoring in a recovery area to ensure stable vital signs and manage any postoperative discomfort. Pain management strategies are implemented to address any discomfort associated with the incisions and the presence of the bar. Patients are usually advised on activity restrictions to promote healing and prevent complications. Follow-up appointments are essential to monitor the positioning of the bar and assess the healing process. The expected recovery time may vary, but many patients can return to normal activities within a few weeks, depending on individual healing and the extent of the procedure.