2025 CPT code 21603
(Active) Effective Date: N/A Revision Date: N/A Excision - Musculoskeletal System Surgery Feed
Excision of chest wall tumor involving rib(s), with plastic reconstruction and mediastinal lymphadenectomy.
Modifiers may be applicable in specific circumstances (e.g., modifier 22 for increased procedural services, modifier 59 for distinct procedural services). Refer to current modifier guidelines.
Medical necessity is established by the presence of a chest wall tumor involving the ribs, requiring surgical excision and reconstruction to restore chest wall integrity and address the underlying pathology. Lymphadenectomy is necessary for staging and treatment planning.
The physician performs the surgical excision of the tumor, the mediastinal lymphadenectomy, and the chest wall reconstruction. This involves incision, dissection, tumor removal, lymph node removal, flap creation and placement, bone grafting or prosthetic placement, wound closure, and drain placement if necessary.
In simple words: The surgeon removes a tumor from the chest wall that involves the ribs. Because removing the tumor and some ribs can create a large hole, the surgeon reconstructs the chest wall using nearby muscle and skin flaps and either bone grafts or synthetic materials. Lymph nodes in the center of the chest are also removed to check for cancer spread.
Excision of a chest wall tumor that involves one or more ribs, necessitating plastic reconstruction. The procedure includes mediastinal lymphadenectomy (removal of lymph nodes in the mediastinum). The reconstruction typically involves myocutaneous flaps and bone grafts or prosthetic materials for the ribs.
Example 1: A patient presents with a large chondrosarcoma involving the 5th and 6th ribs on the right side. The surgeon performs an excision of the tumor, including portions of the affected ribs, and reconstructs the chest wall defect using a latissimus dorsi myocutaneous flap and a prosthetic rib implant.Mediastinal lymph nodes are also removed., A biopsy reveals a malignant chest wall tumor involving a single rib. The patient undergoes excision of the tumor, including the involved rib, and reconstruction of the defect with a myocutaneous flap and an autologous bone graft. Mediastinal lymph node dissection is also performed., A patient with a history of breast cancer develops a recurrence in the chest wall involving the ribs. The surgeon performs a wide excision of the recurrent tumor, removes involved ribs, and performs a complex chest wall reconstruction. A mediastinal lymphadenectomy is also performed to assess for further spread.
Documentation should include the size and location of the tumor, operative report detailing the extent of the resection, type of reconstruction performed (including type of flap and graft/prosthetic used), and confirmation of mediastinal lymph node removal. Pathology reports should confirm the diagnosis and margin status.
- Revenue Code: P1G – Major Procedure - Other
- Payment Status: Active
- Specialties:Thoracic Surgery, Surgical Oncology, Plastic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center