2025 CPT code 21813

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

Refer to the AMA CPT coding guidelines and payer-specific guidelines for proper code utilization.

Modifiers 50 (bilateral procedure), 76 (repeat procedure), and others may be applicable depending on the circumstances.

Medical necessity for this procedure is generally established by the presence of clinically significant rib fractures resulting in respiratory compromise, significant pain, or risk of further complications like pneumothorax or hemothorax.The severity of the fractures and the patient's clinical status will determine the need for surgical intervention.

The surgeon is responsible for performing the open surgical procedure, including incision, dissection, fracture reduction, internal fixation, irrigation, hemostasis (control of bleeding), and wound closure.Preoperative and postoperative care is billed separately.

IMPORTANT 21811 (1-3 ribs), 21812 (4-6 ribs).For bilateral procedures, report 21813 with modifier 50.

In simple words: This code describes a surgery to fix broken ribs.The surgeon opens the chest, realigns the broken bones, and uses plates, screws, or other hardware to hold them in place.A small camera may be used for better visibility.

This CPT code, 21813, reports open surgical treatment of seven or more fractured ribs on one side of the body.The procedure involves an open approach to the rib cage, reduction (realignment) of the fractured rib segments, and internal fixation using devices such as plates, screws, wires, or nails to stabilize the fractures. Thoracoscopic visualization may be included as part of this procedure.

Example 1: A patient presents after a motor vehicle accident with multiple rib fractures on their right side.Imaging reveals 8 fractured ribs.The surgeon performs an open reduction and internal fixation (ORIF) using plates and screws, utilizing thoracoscopy for improved visualization., A patient sustains rib fractures during a fall.A chest CT scan shows 7 fractured ribs on the left side.The surgeon performs an ORIF with internal fixation and thoracoscopic assistance., A patient with a history of osteoporosis presents with multiple rib fractures after a minor fall.The surgeon performs an ORIF of 10 fractured ribs on their right side, using a combination of plates and screws for stabilization.

* Preoperative diagnosis, including imaging studies (chest X-ray, CT scan) demonstrating the rib fractures.* Operative report detailing the surgical approach, number of ribs repaired, type of fixation used, and any intraoperative complications.* Postoperative imaging (chest X-ray) to confirm the reduction and fixation.* Documentation of anesthesia administration and recovery.

** Thoracic surgery expertise is required to perform this procedure safely and effectively.

  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Specialties:Thoracic Surgery, Trauma Surgery, Orthopedic Surgery
  • Place of Service:Inpatient Hospital, Ambulatory Surgical Center
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