CPT® Code 21811

Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribs

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.