How To Use CPT Code 21603

CPT code 21603 describes the excision of a chest wall tumor involving the ribs, with plastic reconstruction and 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 21603?

CPT code 21603 is used to describe the excision of a chest wall tumor that involves the ribs, along with plastic reconstruction and mediastinal lymphadenectomy. This code is used when a provider removes a tumor from the chest wall, including the adjacent ribs, and performs reconstructive surgery to repair any defects. Additionally, the provider may also excise suspicious lymph nodes in the mediastinum during the procedure.

2. Official Description

The official description of CPT code 21603 is: ‘Excision of chest wall tumor involving rib(s), with plastic reconstruction with mediastinal lymphadenectomy.’

3. Procedure

The procedure for CPT code 21603 involves several steps:

1. The patient is appropriately prepped and placed under general anesthesia.
2. The 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 the adjacent ribs above and below the tumor, is excised in its entirety.
5. If there are suspicious lymph nodes in the mediastinum, the provider also excises them.
6. To reconstruct the chest wall defects, the provider uses myocutaneous flaps taken from muscles such as the pectoralis major, latissimus dorsi, rectus abdominis, or serratus anterior.
7. If necessary, the provider repairs the bone defects using autogenous rib grafts or prosthetic materials such as Prolene® or Marlex® mesh and acrylic fiber.
8. Bleeding is controlled using electrocautery or ligation.
9. The surgical wound is closed with layered sutures.
10. A drain may be placed for better healing of the wound.

4. Qualifying circumstances

CPT code 21603 is appropriate for patients who require the excision of a chest wall tumor involving the ribs, along with plastic reconstruction and mediastinal lymphadenectomy. This code is used when the tumor is malignant or suspicious for malignancy. It is important to note that CPT code 21603 should not be reported in conjunction with codes 32100, 32503, 32504, 32551, 32554, or 32555.

5. When to use CPT code 21603

CPT code 21603 should be used when a provider performs the excision of a chest wall tumor involving the ribs, along with plastic reconstruction and mediastinal lymphadenectomy. This code is appropriate for cases where the tumor is malignant or suspicious for malignancy and requires surgical intervention.

6. Documentation requirements

To support a claim for CPT code 21603, the provider must document the following information:

• Patient’s diagnosis and indication for the excision of the chest wall tumor
• Details of the plastic reconstruction performed
• Date of the procedure
• Start and end time of the procedure
• Specific muscles used for myocutaneous flaps, if applicable
• Type of bone grafts or prosthetic materials used for rib reconstruction, if applicable
• Any additional procedures performed, such as mediastinal lymphadenectomy
• Details of bleeding control measures
• Method of wound closure
• Placement of a drain, if applicable

7. Billing guidelines

When billing for CPT code 21603, it is important to ensure that the excision of the chest wall tumor involves the ribs, plastic reconstruction, and mediastinal lymphadenectomy. This code should not be reported in conjunction with codes 32100, 32503, 32504, 32551, 32554, or 32555. It is also important to follow any specific billing guidelines provided by the payer.

8. Historical information

CPT code 21603 was added to the Current Procedural Terminology system on January 1, 2020. It was initially included in the Inpatient Only (IPO) list for Medicare, but was later removed in 2021. However, it was added back to the IPO list in 2022.

9. Similar codes to CPT code 21603

There are several similar codes to CPT code 21603 that involve excision procedures on the neck (soft tissues) and thorax. These include:

• 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
• CPT 21555: Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); greater than 5 cm
• CPT 21601: Excision, tumor, chest wall, malignant; without plastic reconstruction

9. Examples

1. A patient undergoes excision of a chest wall tumor involving the ribs, with plastic reconstruction and mediastinal lymphadenectomy for a suspected chondrosarcoma.
2. A provider performs the excision of a chest wall tumor involving the ribs, with plastic reconstruction and mediastinal lymphadenectomy for a patient with a fibrosarcoma.
3. An individual undergoes the excision of a chest wall tumor involving the ribs, with plastic reconstruction and mediastinal lymphadenectomy for an osteosarcoma.
4. A patient with a chondroblastoma undergoes the excision of a chest wall tumor involving the ribs, with plastic reconstruction and mediastinal lymphadenectomy.