CPT 21740: Chest Wall Reconstruction for Pectus Deformity Repair
CPT code 21740 represents surgical reconstruction of the chest wall to repair congenital deformities such as pectus excavatum and pectus carinatum. This procedure is clinically significant because it can address functional impairments (respiratory and cardiac impact) and cosmetic concerns, and it is performed across pediatric and adult populations. Nationally, the code is relevant for payers managing coverage for corrective thoracic procedures and for facilities tracking surgical case mix and outcomes.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise clinical and billing profile of the procedure, including its service type and typical sites of service. The publication summarizes common billing modifiers associated with surgical services, highlights expected clinical contexts for use, and outlines what to expect in payer coverage discussions. It also provides benchmarking context and policy-oriented considerations applicable at the national level.
The piece is intended to help billing managers, surgeons, and policy analysts understand the code’s clinical scope, administrative considerations, and where to look for further payer-specific guidance. Data not available in the input are noted where applicable.
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Billing Code Overview
CPT code 21740 describes surgical reconstruction of the chest wall to correct congenital deformities such as pectus excavatum (sunken chest) and pectus carinatum (protruding sternum). The procedure involves repair and reshaping of the sternum and adjacent chest wall structures to restore normal thoracic contour and function.
Service type: Surgical — chest wall reconstruction for congenital deformity
Typical site of service: Inpatient or outpatient hospital surgical setting depending on case complexity, patient age, and perioperative needs. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 16-year-old male with symptomatic pectus excavatum presents to a thoracic surgery clinic for evaluation. He reports exertional dyspnea and decreased exercise tolerance; physical exam demonstrates a sunken anterior chest with sternal depression. Imaging includes chest radiograph and CT chest confirming significant sternal depression and cardiopulmonary compression. Pulmonary function testing shows a mild restrictive pattern. After preoperative evaluation and counseling, the patient is scheduled for surgical chest wall reconstruction to repair the congenital deformity.
The clinical workflow includes: preoperative assessment by the thoracic surgery team and anesthesia, imaging review, informed consent, operative planning (possible use of prosthetic bars or cartilage reshaping), the reconstructive procedure in the operating room with general anesthesia, intraoperative monitoring, postoperative chest radiograph, pain control, inpatient recovery with pulmonary toileting and physical therapy, and outpatient follow-up for wound check and functional assessment. Documentation includes indication, operative report with technique and materials, estimated blood loss, implants used, and follow-up plan for functional outcomes and potential hardware removal if applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or time substantially exceeds typical for the procedure (document rationale). |
52 | Reduced services | Use when the procedure is partially reduced or not completed as originally planned. |
53 | Discontinued procedure | Use when aborted due to extenuating circumstances prior to completion. |
62 | Two surgeons | Use when two surgeons of different specialties work together as primary surgeons. |
66 | Surgical team | Use when a surgical team approach is used (team documented). |
76 | Repeat procedure by same physician | Use if the same physician repeats the procedure during the postoperative period. |
77 | Repeat procedure by another physician | Use if another physician repeats the procedure during the postoperative period. |
80 | Assistant surgeon | Use when an assistant surgeon performs part of the procedure (documented role). |
81 | Minimum assistant surgeon | Use when a minimal assistant role is documented. |
62 | Two surgeons | Use when two surgeons of different specialties work together as primary surgeons. |
24 | Unrelated E/M service during postoperative period | Use when an unrelated evaluation and management service occurs during the global period. |
25 | Significant, separately identifiable E/M service on same day | Use when a significant E/M service is provided the same day as the procedure. |
50 | Bilateral procedure | Use when bilateral chest wall reconstruction is performed and modifier is supported by payer policy. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208U00000X | Thoracic Surgery | Primary specialty performing chest wall reconstructions. |
| 2080P0202X | General Surgery | Some general surgeons with thoracic expertise perform repair. |
| 207P00000X | Pediatric Surgery | Pediatric surgeons perform repairs in adolescents and children. |
| 2084P0800X | Plastic Surgery | Plastic surgeons assist with cosmetic and reconstructive aspects. |
| 2086S0126X | Cardiothoracic Surgery | Cardiothoracic surgeons perform complex chest wall reconstructions. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Q67.6 | Pectus excavatum | Primary congenital indication for chest wall reconstruction to correct sternal depression. |
Q67.7 | Pectus carinatum | Protruding sternum deformity that may require reconstructive correction. |
Q76.3 | Congenital malformation of sternum | Includes sternal anomalies addressed during reconstruction. |
M95.0 | Postoperative chest wall deformity | Relevant for revision or corrective reconstruction procedures. |
R06.02 | Shortness of breath, orthopnea | Symptom that may prompt functional repair when attributable to deformity. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19318 | Reduction mammaplasty | May be performed concomitantly for chest wall symmetry or access in some patients. |
21745 | Resection of rib(s) or cartilage, without prosthetic reconstruction | Alternative or adjunct when cartilage resection is required without full reconstruction. |
21930 | Excision of chest wall tumor, partial rib resection | Performed when chest wall deformity is associated with pathology requiring resection. |
31899 | Unlisted procedure, thoracic | Used for thoracic procedures not described by other CPT codes when unique techniques are performed. |
19350 | Nipple/areola reconstruction | Performed by plastic surgery when aesthetic chest reconstruction includes breast/nipple reconstruction in select patients. |