Wiki Sternum Reconstruction

ccallycat

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My provider performed a Radical sternectomy, bilateral resection of clavicles, resection of ribs 1-4 (bilateral) (and misc. other procedures to do with flaps) on a patient with sarcoma of sternum, status post x-ray beam radiation therapy, and history of Hodgkin lymphoma. When I focus in on code 21630 states it includes removal of sternum, all accompanying subcutaneous tissues, pectoralis major muscle, cartilages of the first several ribs, and states the provider irrigates the area and suture surgical mesh material to the chest wall to cover defect. My provider reconstructed/created a "new" sternum made out of mesh and methyl methacrylate. Is there a code for this reconstruction of sternum? I see one for reconstruction of clavicle 23490, but not for sternum. The 21630 says surgical mesh attached to chest wall to cover defect, but doesn't state it being used in addition to material to create new sternum.


His op report states "We then reconstructed the sternum using methyl methacrylate, 2 packages of the methyl methacrylate without antibiotic was mixed and "new" sternum was created to fill the voice exactly; it was approximately 12.5cm long by 4cm wide by 1cm thick and it embedded in two layers of polyproplylene mesh. Once this was hardened, it was put up into the patient and it looked quite good and matched the body of the sternum. We then used sternal plating using 10mm screws through the methyl methacrylate sternum to the body of the sternum securely. The biomesh was sewn first, covering the anterior mediastinum. We did cover the mediastinum with synthess DePuy Biomesh which was quite long and wide. It was called XCM biologic tissue matrix, which was laid on the undersurface of ribs 1-4 and the clavicle was covered and covered the anterior mediastinum and was fixated to the ribs using 0 prolene suture. This was done in sandwich formation after which the polyproplylene mesh with the embedded artificial sternum was then also fixated anteriorly to the ribs using the same prolene suture…."

Thanks for any input!
 
I did wind up using 21899 and wrote up letter attached to the HCFA stating that it was close to 21740 however not congenital and 23490 (clavicle), quoted the op report and attached a copy, and of course BCBS denied. I'm currently on Level one appeal with them. This is going to be a battle!
 
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