Summary & Overview
CPT 21620: Partial Sternum Resection for Lesion or Infection
CPT code 21620 denotes partial removal of the sternum to address lesions, abnormal bony growths, bone infection, or necrotic sternum. This thoracic surgical code is relevant nationally for hospitals and surgical practices managing complex chest wall pathology and for payers that cover thoracic surgical services. The code informs billing, clinical documentation, utilization monitoring, and reimbursement for procedures requiring an operating room and often multidisciplinary care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for using 21620, typical sites of service, and the payer mix that influences coverage and prior authorization practices. The publication covers benchmarks and utilization patterns where available, common modifier usage and coding considerations (when data is present), and policy updates that may affect coverage or documentation requirements.
The content is designed to help billing managers, surgical teams, and policy analysts understand the code's clinical scope, the payer landscape, and the types of documentation often required to support claims for sternum resection procedures under CPT code 21620.
Billing Code Overview
CPT code 21620 describes a surgical procedure in which the provider removes a portion of the patient's sternum (breast bone). The procedure is performed to treat lesions, abnormal bony protrusions, osteomyelitis (bone infection), or necrotic bone affecting the sternum.
Service type: Surgical resection of bone (thoracic)
Typical site of service: Operating room or other inpatient/outpatient surgical setting depending on clinical need
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with a history of chronic sternal osteomyelitis following prior median sternotomy presents with persistent localized pain, erythema, and draining sinus at the lower sternal incision despite prolonged intravenous antibiotics. Imaging (CT chest) demonstrates sequestrum and focal necrotic portion of the body of the sternum. The cardiothoracic surgical team schedules operative debridement and limited partial sternectomy to remove diseased bone and allow soft-tissue closure with possible muscle flap coverage.
Preoperative workflow includes history and physical, infection workup with blood cultures, CT imaging to define the extent of bony involvement, anesthesia evaluation, and informed consent documenting the extent of bone resection. Intraoperative documentation should note the exact portion of the sternum removed, indication (infection/necrosis), concurrent procedures (eg, debridement, closure with flap), estimated blood loss, and specimens sent for culture and pathology. Postoperative care includes intravenous antibiotics guided by cultures, wound and flap monitoring, and follow-up imaging as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When documented work, time, or complexity for the partial sternectomy is substantially greater than typical for 21620. |