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The procedure described by CPT® Code 21812 involves the open treatment of rib fractures, specifically addressing cases where there are 4 to 6 fractures present. This surgical intervention is characterized by the use of open reduction and internal fixation (ORIF) techniques, which are essential for properly aligning and stabilizing the fractured ribs. The term 'unilateral' indicates that the procedure is performed on one side of the rib cage. In some instances, thoracoscopic visualization may be utilized during the surgery, allowing the surgeon to examine the pleural cavity for any potential complications such as bleeding or damage to surrounding visceral organs. The surgical approach begins with a standard thoracotomy incision, which is made over the area of injury, and involves careful dissection through the skin, subcutaneous tissue, and fascia to access the ribs. The procedure requires meticulous attention to avoid damaging the intercostal neurovascular bundles, which are critical structures located along the inferior aspect of the ribs. Once the fractures are exposed, the surgeon cleans the fracture sites, removes any nonunion fibrous tissue, and then mobilizes, reduces, and secures the fractured rib ends using various fixation devices. The closure of the surgical site involves reapproximating the muscles, closing the fascia and subcutaneous tissue with interrupted stitches, and finally securing the skin with staples. This comprehensive approach ensures that the rib fractures are effectively treated, promoting optimal healing and recovery.
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The open treatment of rib fractures with internal fixation, as described by CPT® Code 21812, is indicated for patients presenting with the following conditions:
The procedure for the open treatment of rib fractures with internal fixation involves several critical steps:
Post-procedure care following the open treatment of rib fractures with internal fixation includes monitoring for any complications such as infection, bleeding, or respiratory issues. Patients are typically advised to manage pain effectively, which may involve the use of analgesics. Additionally, respiratory therapy may be recommended to promote lung expansion and prevent complications such as pneumonia. Follow-up appointments are essential to assess the healing of the fractures and the integrity of the fixation devices. Patients should be educated on activity restrictions and the importance of avoiding movements that could jeopardize the surgical repair during the initial recovery phase.
| Short Descr | TREATMENT OF RIB FRACTURE | Medium Descr | OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS | Long Descr | Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 4-6 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). | 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. | 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). | 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. | 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). | 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 | CR | Catastrophe/disaster related | 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) | 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 |
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| 2015-01-01 | Added | Added |
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