How To Use CPT Code 21742

CPT 21742 describes the reconstructive repair of pectus excavatum or carinatum using a minimally invasive approach known as the Nuss procedure. 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 21742?

CPT 21742 is used to describe the reconstructive repair of pectus excavatum or carinatum using a minimally invasive approach called the Nuss procedure. This procedure involves making small incisions through which the provider repairs congenital deformities, such as a sunken or protruding chest, by reconstructing the chest wall.

2. Official Description

The official description of CPT code 21742 is: ‘Reconstructive repair of pectus excavatum or carinatum minimally invasive approach (Nuss procedure), without thoracoscopy.’

3. Procedure

The provider begins the procedure by making two small skin incisions along the midaxillary line on both sides of the sternum. Using blunt dissection outside of the pleura, the provider creates a tunnel between the two incisions to the edge of the sternum. A previously shaped steel bar is then passed into the extrapleural tunnel and rotated to correct the deformity. The bar is secured to the chest wall fascia using sutures, and the skin incisions are closed with sutures.

4. Qualifying circumstances

CPT 21742 is performed on patients with congenital deformities, such as pectus excavatum (sunken chest) or pectus carinatum (protruding sternum). The procedure is considered minimally invasive and does not involve thoracoscopy. It is important to note that the procedure should only be performed by a qualified provider with expertise in the Nuss procedure.

5. When to use CPT code 21742

CPT code 21742 should be used when a provider performs the reconstructive repair of pectus excavatum or carinatum using the Nuss procedure without thoracoscopy. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 21742, the provider must document the following information:

• Patient’s diagnosis of pectus excavatum or carinatum
• Description of the procedure performed, including the use of the Nuss procedure and absence of thoracoscopy
• Date of the procedure
• Details of the surgical approach, including the location and size of the incisions
• Description of the corrective measures taken, such as the placement and fixation of the steel bar
• Any complications or additional procedures performed
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 21742, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The procedure should be performed without thoracoscopy and using the Nuss procedure. It is also important to follow any additional guidelines provided by payers or coding authorities.

8. Historical information

CPT 21742 was added to the Current Procedural Terminology system on January 1, 2003. There have been no updates to the code since its addition.

9. Similar codes to CPT 21742

There are several similar codes to CPT 21742 that describe other procedures for the repair, revision, and reconstruction of soft tissues in the neck and thorax. Some examples include:

• CPT 21685: Reconstructive repair of pectus excavatum or carinatum using an open approach
• CPT 21740: Reconstructive repair of chest wall, not otherwise specified
• CPT 21743: Reconstructive repair of pectus excavatum or carinatum using a minimally invasive approach with thoracoscopy
• CPT 21744: Reconstructive repair of pectus excavatum or carinatum using an open approach with thoracoscopy
• CPT 21750: Reconstructive repair of chest wall, not otherwise specified, with thoracoscopy

9. Examples

1. A provider performs a reconstructive repair of pectus excavatum using the Nuss procedure on a patient with a sunken chest.
2. A patient with pectus carinatum undergoes a minimally invasive repair using the Nuss procedure without thoracoscopy.
3. A provider corrects a congenital deformity in a patient’s chest using the Nuss procedure, addressing both pectus excavatum and carinatum.
4. A teenager with pectus excavatum undergoes a reconstructive repair using the Nuss procedure to improve their chest appearance and respiratory function.
5. A provider performs a minimally invasive repair of pectus carinatum using the Nuss procedure, allowing the patient to achieve a more symmetrical chest shape.
6. A young adult with pectus excavatum undergoes a reconstructive repair using the Nuss procedure to alleviate symptoms and improve their self-esteem.
7. A provider corrects a protruding sternum deformity in a child using the Nuss procedure, resulting in improved chest wall alignment.
8. A patient with pectus carinatum undergoes a minimally invasive repair using the Nuss procedure, allowing for a more natural chest contour.
9. A provider performs a reconstructive repair of pectus excavatum using the Nuss procedure on an adult patient, addressing both cosmetic and functional concerns.
10. A teenager with pectus carinatum undergoes a minimally invasive repair using the Nuss procedure to correct the protruding sternum and improve their chest appearance.