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The procedure described by CPT® Code 21811 involves the open treatment of rib fractures, specifically focusing on the repair of 1 to 3 unilateral rib fractures using internal fixation techniques. This surgical intervention may include thoracoscopic visualization, which allows the surgeon to examine the pleural cavity for any potential bleeding or damage to visceral organs. The process begins with a standard thoracotomy incision, which is made over the area of the rib injury. This incision is carefully extended through the subcutaneous tissue and fascia to access the underlying muscles. The intercostal muscles, which are located between the ribs, are incised at their superior borders to provide adequate exposure to the fractured ribs. Once the fracture sites are accessible, the surgeon cleans the areas and removes any nonunion fibrous tissue that may impede healing. It is crucial during this step to avoid damaging the intercostal neurovascular bundles located at the inferior aspect of the ribs, as these structures are vital for maintaining sensation and blood supply to the area. After mobilizing the fractured ends of the ribs, the surgeon reduces the fractures and secures them in place using various types of internal fixation hardware, which may include metal plates, intramedullary fixation devices, Judet struts, absorbable plates, or U-plates. The option for thoracoscopic visualization can be utilized at any point during the procedure to enhance the assessment and management of the injury. Following the fixation of the ribs, the muscles are reapproximated using a running stitch to ensure proper healing and support. The fascia and subcutaneous tissue layers are then closed with interrupted stitches, and the skin is typically closed using staples. It is important to note that the specific code 21811 is designated for procedures limited to the repair of 1 to 3 rib fractures, while different codes are assigned for the treatment of additional fractures, such as code 21812 for 4 to 6 fractures and code 21813 for 7 or more fractures.
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The open treatment of rib fractures with internal fixation, as described by CPT® Code 21811, is indicated for patients presenting with unilateral rib fractures. The specific indications for this procedure include:
The procedure for the open treatment of rib fractures with internal fixation involves several critical steps, which are outlined as follows:
Post-procedure care following the open treatment of rib fractures with internal fixation includes monitoring for complications such as infection, bleeding, or respiratory issues. Patients are typically advised to manage pain with prescribed medications and may be instructed on breathing exercises to promote lung expansion and prevent complications such as pneumonia. Follow-up appointments are essential to assess the healing process and ensure that the rib fractures are properly aligned and stable. Rehabilitation may be recommended to restore strength and mobility in the affected area, and patients should be educated on activity restrictions to avoid undue stress on the healing ribs.
| Short Descr | OPTX OF RIB FX W/FIXJ SCOPE | Medium Descr | OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS | Long Descr | Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribs | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | 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) | 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 | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 |
| 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). | 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. 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. | 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.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | ET | Emergency services | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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