How To Use CPT Code 21602

CPT code 21602 describes the excision of a chest wall tumor involving the ribs, with plastic reconstruction without mediastinal lymphadenectomy. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 21602?

CPT code 21602 is used to describe the excision of a chest wall tumor that involves the ribs, along with plastic reconstruction. This procedure is performed by a healthcare provider to remove the tumor and reconstruct the chest wall using myocutaneous flaps and bone grafts or prosthetic materials for the ribs. It does not involve the removal of mediastinal lymph nodes.

2. Official Description

The official description of CPT code 21602 is: ‘Excision of chest wall tumor involving rib(s), with plastic reconstruction without mediastinal lymphadenectomy.’

3. Procedure

The procedure for CPT code 21602 involves the following steps:

1. The patient is appropriately prepped and placed under general anesthesia.
2. The healthcare provider makes an incision in the chest wall to access the tumor.
3. The provider dissects through the subcutaneous tissues, fascia, and muscle to reach the tumor.
4. The tumor, along with surrounding soft tissues and adjacent ribs above and below the tumor, is excised in its entirety.
5. After the excision, the provider reconstructs the chest wall using myocutaneous flaps taken from muscles such as the pectoralis major, latissimus dorsi, rectus abdominis, or serratus anterior.
6. To repair the bone defect, the provider may use autogenous rib grafts or prosthetic materials such as Prolene® or Marlex® mesh and acrylic fiber.
7. Bleeding is controlled using electrocautery or ligation.
8. The surgical wound is closed with layered sutures.
9. A drain may be placed into the depths of the wound for better healing and drainage.

4. Qualifying circumstances

CPT code 21602 is used for patients who require the excision of a chest wall tumor involving the ribs, along with plastic reconstruction. The procedure is performed by a healthcare provider who is qualified to perform this type of surgery. It is important to note that this code does not involve the removal of mediastinal lymph nodes.

5. When to use CPT code 21602

CPT code 21602 should be used when a healthcare provider performs the excision of a chest wall tumor involving the ribs, along with plastic reconstruction. It is important to ensure that the procedure does not involve the removal of mediastinal lymph nodes. If mediastinal lymphadenectomy is performed, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT code 21602, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for excision of the chest wall tumor
• Details of the procedure, including the specific techniques used for excision and reconstruction
• Date of the procedure
• Start and end time of the procedure
• Any complications or unexpected findings during the procedure
• Details of the reconstruction materials used, such as myocutaneous flaps, autogenous rib grafts, or prosthetic materials
• Control of bleeding and closure of the surgical wound
• Placement of a drain, if applicable
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 21602, it is important to ensure that the procedure meets the criteria for this code. The excision of the chest wall tumor involving the ribs, along with plastic reconstruction, should be documented in the medical record. It is also important to note that CPT code 21602 should not be reported in conjunction with codes for resection of an apical lung tumor (such as CPT codes 32503 or 32504) as chest wall reconstruction is included in those codes.

8. Historical information

CPT code 21602 was added to the Current Procedural Terminology system on January 1, 2020. It was initially added as a non-inpatient only (non-IPO) code. However, it was later added to the Inpatient Only (IPO) list in 2020 and removed from the IPO list in 2021. As of 2022, it is once again included in the IPO list.

9. Similar codes to CPT code 21602

There are several similar codes to CPT code 21602 that describe excision procedures on the neck (soft tissues) and thorax. Some of these codes include:

• CPT 21601: Excision of chest wall tumor including ribs, without plastic reconstruction
• CPT 21603: Excision of chest wall tumor involving ribs, with plastic reconstruction and mediastinal lymphadenectomy
• CPT 21550: Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm
• CPT 21552: Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm
• CPT 21554: Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); 5 cm or greater

9. Examples

1. A healthcare provider performs the excision of a chest wall tumor involving the ribs and reconstructs the chest wall using myocutaneous flaps and autogenous rib grafts.
2. During the procedure, the healthcare provider excises a chest wall tumor and reconstructs the chest wall using myocutaneous flaps and prosthetic materials for the ribs.
3. A patient undergoes the excision of a chest wall tumor involving the ribs, and the chest wall is reconstructed using myocutaneous flaps and acrylic fiber.
4. The healthcare provider performs the excision of a chest wall tumor and reconstructs the chest wall using myocutaneous flaps and Marlex® mesh.