Reporting Rib Fracture Treatment in 2015
New codes require you to rethink code selection.
By G.J. Verhovshek, MA, CPC
CPT® 2015 radically changes how you report treatment of rib fractures this year. External fixation is now coded as an unlisted procedure, while open treatment options are defined by new codes and differentiated by the number of ribs involved.
Say Goodbye to Infrequently-used Treatment Options
CPT® 2015 deleted two rib fracture codes describing treatments used infrequently in current medical practice:
21800 Closed treatment of rib fracture, uncomplicated, each
Per CPT® instruction, you should now report closed treatment of an uncomplicated rib fracture using an appropriate evaluation and management (E/M) code, as determined by patient status (new or established), place of service (outpatient or inpatient), and documented level of care. A closed reduction means the fracture is set (reduced) using manipulation, without surgery.
21810 Treatment of rib fracture requiring external fixation (flail chest)
Open (surgical) treatment of rib fractures using internal fixation has become much more common than external fixation, and CPT® 2015 includes new codes to report these services (21811-21813). If the provider performs treatment of rib facture with external fixation, CPT® directs you to report unlisted procedure code 21899 Unlisted procedure, neck or thorax.
Say Hello to Category I for Open Tx with Internal Fixation
In previous years, open treatment of rib fracture using internal fixation was reported using CPT® Category III codes 0245T-0248T. Those codes are now deleted, replaced by Category I codes with similar descriptions:
21811 Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribs
21812 Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 4-6 ribs
21813 Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 7 or more ribs
As you may deduce from the code descriptors, code selection is based on the number of ribs treated. Thorascopic guidance is included, and may not be reported separately. Additionally, 21811-21813 are unilateral (single sided) procedures to which you may append modifier 50 Bilateral procedure, when appropriate.
Example 1: Using open treatment with internal fixation, the provider reduces fracture of three ribs on the left side. Proper coding is 21811.
Example 2: Using open treatment with internal fixation, the provider reduces fracture of four ribs on the left side and four ribs on the right side. Proper coding is 21812-50.
When reporting reduction by internal fixation, coding is less certain when an unequal number of ribs, described by distinct codes, are treated on opposite sides of the body. For instance, using open treatment with internal fixation, the provider reduces fracture of three ribs on the left side and five ribs on the right side. In such a case, a reasonable assumption would be to report the appropriate codes independently and apply anatomic modifiers LT Left side and RT Right side to specify laterality (e.g., 21811-LT and 21812-RT). But we all know what happens when one assumes. Perhaps a future edition of CPT® Assistant will address this issue.
G.J. Verhovshek, MA, CPC, is managing editor at AAPC, and a member of the Asheville-Hendersonville, North Carolina, local chapter.