# Question about rib fracture repair



## Robin R (Apr 20, 2010)

Good morning!

One of my trauma surgeons is performing an open rib fracture repair on three ribs (4th, 5th, 6th) using an internal plating system.

CPT 21805 is for rib fracture treatment without fixation & 21810 is for external fixation.  

What do you use for internal fixation only???

Thank you for your help!


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## DOVERRED (Apr 20, 2010)

Might want to ask your doc if he did indeed use a internal fixation and not a external fixator?


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## Robin R (Apr 20, 2010)

Yes, it was definitely internal only.

He titles the OP note "Rib fracture repair - open with internal fixation using rib plating system by Acute Innovations."

OP note reads:

An incision was made from the tip of the scapula anteriorly
for approximately 15 cm.  This was carried down through the subcutaneous
tissues and the muscle was divided using electrocautery.  The portion of the
latissimus and a small portion of his pectoralis were divided to access his rib
fracture fragments.  His ribs were cleaned off at the site of the fracture at
the 5th rib and then again at the 6th rib. There was some fibrous nonunion at
both rib sites and this was cleaned out and the edges of the fracture sites
were reduced and placed in line.  The 1st rib to be plated was the 6th rib and
a 12 mm U-shaped plate was used after measurement.  The plate was placed over
the superior portion of the rib after it was cleaned off of all its muscular
attachments and using the guide, holes were drilled into the bone and the
appropriate color-coordinated screws were placed to affix the plate in place. 

Attention was then turned to the 5th rib where a similar procedure was
undertaken to clean out the fibrous nonunion, reduce the ribs, align the ends
and fit a U-shaped plate. Again, a 12 mm plate was used and secured in place
using the guide.  

Attention was then turned to the 4th rib which was cleaned off in a similar
manner and using the scapula retractor to gain optimal exposure, this rib was
also reduced at the anterior fracture site, the fibrous malunion was excised
and the rib ends reduced.  A 3rd plate was placed over this rib and secured in
place using the guide without any difficulties.  At no point was the pleural
space violated during application of the rib fracture plates and the entire
procedure was performed through a single incision.  The muscle was
reapproximated using 2-0 Vicryl running suture.  The fascia and subcutaneous
tissues were reapproximated using 2-0 Vicryl sutures and the skin was stapled
closed.


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## Robin R (Apr 20, 2010)

dr wants to use CPT 32820 AND 21805-22


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## DOVERRED (Apr 20, 2010)

I ccame up with 21899 unlisted code unfortunately


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## Robin R (Apr 20, 2010)

I was afraid of that!!!  

Thanks so much!


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## mrsalexander (Dec 14, 2010)

*Category iii codes*

I also had a hard time trying to figure out what code to use for rib loc plating (internal fixation). I do see in CPT 2011 that there is a Category III code (0245T). Has anyone every used a Cat III code before? I have not. Do you list it just like the other CPT's? thanks


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## rcerro (May 16, 2012)

*rcerro*

I use them with the orif of the ribs.  They are payable for MCR with review as a status "C" catagory III code.  I am having success in getting these paid with medical necessity.  I starte with the catagory III code on them all, but some insurance comp (work comp, auto, smaller companies, and Medicaids) some times can't process it.  In that event I switch it to an unlisted code.  Good luck


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