CPT® Code 21813

Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 7 or more ribs

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.