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The procedure described by CPT® Code 21813 involves the open treatment of rib fractures, specifically when there are seven or more ribs affected. This surgical intervention is characterized by the use of internal fixation techniques, which are essential for stabilizing the fractured ribs and promoting proper healing. The term "unilateral" indicates that the procedure is performed on one side of the body, targeting the ribs on that side. During the operation, thoracoscopic visualization may be employed, allowing the surgeon to use a thoracoscope—a thin, lighted tube—to view the pleural cavity. This visualization is crucial for assessing any potential bleeding or damage to the surrounding visceral organs, which may occur due to the rib fractures. The surgical approach begins with a standard thoracotomy incision, which is made over the area of injury. This incision allows access to the underlying structures, including the subcutaneous tissue and fascia. The muscles that cover the ribs are carefully retracted, and the intercostal muscles are incised at the superior borders of the ribs to expose the fracture sites. Once the fractures are visible, the surgeon cleans the fracture sites and removes any nonunion fibrous tissue that may impede healing. It is important to avoid damaging the intercostal neurovascular bundles located at the inferior aspect of the ribs during this process. After mobilizing and reducing the fractured ends of the ribs, the surgeon secures them in place using various types of hardware, such as metal plates, intramedullary fixation devices, Judet struts, absorbable plates, or U-plates. The use of these fixation devices is critical for ensuring that the ribs remain properly aligned during the healing process. The procedure concludes with the reapproximation of the muscles using a running stitch, followed by the closure of the fascia and subcutaneous tissue with interrupted stitches. Finally, the skin is closed using staples. It is important to note that different CPT codes are utilized based on the number of rib fractures treated: CPT® Code 21811 is designated for the repair of 1-3 rib fractures, CPT® Code 21812 for 4-6 fractures, and CPT® Code 21813 for 7 or more rib fractures.
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The open treatment of rib fractures with internal fixation, as described by CPT® Code 21813, is indicated for patients who have sustained significant rib injuries. 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 distress. Patients may require pain management to facilitate recovery and improve mobility. It is essential to provide instructions on activity restrictions to prevent stress on the surgical site during the healing process. Follow-up appointments are necessary to assess the healing of the fractures and the integrity of the fixation devices. Rehabilitation may be recommended to restore strength and function to the thoracic region.
| Short Descr | TREATMENT OF RIB FRACTURE | Medium Descr | OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS | Long Descr | Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 7 or more 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 |
| 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). | 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. | 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 | 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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