Summary & Overview
CPT 21630: Total Sternectomy for Malignant Sternal Tumor
CPT code 21630 denotes total sternectomy, the complete surgical removal of the sternum most often performed for malignant tumors of the breastbone. As an extensive oncologic procedure, it carries implications for hospital resource use, perioperative planning, and specialist surgical coding nationally. Payers typically involved in coverage and reimbursement decisions for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. This publication provides a concise reference on the clinical scope and billing context of 21630, explaining the procedure's role in cancer management and the typical inpatient surgical setting. Readers will get a clear clinical description, expected site-of-service designation, and an outline of which major payers are relevant. Where available, the piece summarizes common billing considerations and documentation elements that influence claims processing and payer review. Data not available in the input is noted where applicable. The material is intended for coding professionals, hospital billing staff, and policy analysts seeking a national-level briefing on this high-acuity surgical oncology code.
Billing Code Overview
CPT code 21630 describes total sternectomy, the surgical removal of the entire sternum (breastbone). This procedure is typically performed to treat malignant bone tumors of the sternum when resection is required for cancer control.
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Service type: Major surgical oncology procedure
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Typical site of service: Inpatient hospital surgical suite with postoperative hospital care
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with progressively worsening anterior chest wall pain and radiographic evidence of a destructive sternal lesion undergoes evaluation that includes chest CT, bone scan, and core biopsy confirming primary malignant bone tumor of the sternum (e.g., chondrosarcoma). The surgical plan is en bloc resection of the entire sternum (total sternectomy) to achieve oncologic margins. Preoperative workflow includes multidisciplinary tumor board review, cardiothoracic surgical consent, anesthesia evaluation, and discussion of reconstructive options (prosthetic mesh and pectoralis major flap). On the day of service, the patient is admitted to an operating room; cardiothoracic surgery performs the 21630 procedure with appropriate intraoperative monitoring, possible partial rib resections, and immediate chest wall reconstruction. Postoperative care includes ICU monitoring for hemodynamic and respiratory status, pain control, chest physiotherapy, wound and flap surveillance, and coordination of adjuvant oncology treatment if indicated. Typical site of service is an inpatient acute care hospital, frequently performed by cardiothoracic or surgical oncology teams.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure requires substantially greater work than usual due to extensive resection or reconstruction. |