2025 CPT code 21601
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Musculoskeletal System Surgery Feed
Excision of chest wall tumor including rib(s).
Modifiers may apply depending on the circumstances of the procedure.For example, modifier 54 (surgical care only) may be used if the surgeon only performs the surgical procedure and does not provide postoperative care. Modifiers 76 (repeat procedure) or 78 (unplanned return to OR) can be used depending on circumstances.
Medical necessity is established by the presence of a chest wall tumor requiring surgical excision.Documentation should support the diagnosis, size, location of the tumor, and the need for rib resection.
The surgeon makes an incision, dissects to the tumor, excises the tumor and involved ribs, controls bleeding, and closes the wound.A drain may be placed.
In simple words: The doctor removes a tumor from the chest wall, which may include taking out some ribs.The surgery involves cutting the skin, removing the tumor and nearby tissue, and closing the wound.
This CPT code 21601 represents the surgical excision of a chest wall tumor that involves one or more ribs.The procedure includes incision, dissection to the fascia and chest muscles (extent depending on tumor size), complete tumor excision with surrounding soft tissues and adjacent ribs above and below the tumor, intercostal muscle resection, hemostasis (bleeding control via electrocautery or ligation), and layered wound closure. A drain may be placed.This does not include plastic reconstruction.
Example 1: A 60-year-old patient presents with a palpable mass on the anterior chest wall. Imaging reveals a 4cm chondrosarcoma involving the 4th rib. The surgeon performs a resection including the involved rib and surrounding tissue, using code 21601., A 45-year-old patient with a history of breast cancer presents with chest wall recurrence. Imaging shows involvement of the 2nd and 3rd ribs.The surgeon performs an en bloc resection of the tumor and involved ribs using code 21601., A 70-year-old patient has a benign chest wall tumor discovered incidentally during a cardiac catheterization.The tumor, measuring 3 cm, involves the 5th rib and is excised using code 21601.No reconstruction is required.
Preoperative imaging (CT, MRI), operative report detailing the extent of resection (including ribs removed), pathology report confirming diagnosis and margins, and postoperative imaging if indicated.
** If significant reconstruction is required following the excision, codes for reconstruction should be reported separately.The size and extent of the tumor dictate the surgical approach and the extent of rib resection.Consultation with a thoracic surgeon or oncologist may be necessary.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Thoracic Surgery, Surgical Oncology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center