Summary & Overview
CPT 21742: Minimally Invasive Chest Wall Reconstruction for Pectus Deformities
CPT code 21742 represents minimally invasive surgical reconstruction of the chest wall to correct congenital deformities such as pectus excavatum and pectus carinatum. This code captures procedures performed through small incisions to restore chest wall contour and function. Nationally, these procedures are clinically significant for pediatric and young adult populations with symptomatic or cosmetically concerning deformities and are part of broader reconstructive thoracic surgical services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the service type associated with CPT code 21742. The publication provides benchmarks where available, notes on payer coverage patterns, and policy considerations that influence authorization and billing for chest wall reconstruction.
This summary helps clinicians, billing professionals, and policy analysts understand the code's clinical purpose, expected care settings, and payer landscape on a national level. Data not available in the input is explicitly noted where relevant.
Billing Code Overview
CPT code 21742 describes minimally invasive reconstruction of the chest wall to repair congenital deformities such as pectus excavatum (sunken chest) or pectus carinatum (protruding sternum). The procedure is performed through small incisions and involves reconstructive techniques to correct chest wall contour and structural abnormalities.
Service Type: Surgical — Chest Wall Reconstruction (Minimally Invasive)
Typical Site of Service: Inpatient or outpatient surgical setting (operating room or ambulatory surgery center)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 16-year-old adolescent male presents with progressive pectus excavatum causing chest wall depression, cosmetic concern, and exertional dyspnea. After clinical evaluation and imaging (chest radiograph and CT or MRI to assess severity and cardiac compression), the surgical team elects minimally invasive repair of the chest wall. The procedure is performed in an operating room under general anesthesia with single-lumen or double-lumen endotracheal intubation as indicated. Small lateral thoracic incisions are made for placement of a substernal support bar (or equivalent implant) and guided visualization; the depressed sternum is elevated and stabilized to correct the deformity. Intraoperative monitoring includes cardiac and respiratory parameters; chest tubes may be placed if pleural entry occurs. The typical workflow includes preoperative assessment (anesthesia evaluation, informed consent), operative repair using small incisions with placement of corrective hardware, immediate postoperative recovery in the PACU, and admission to an inpatient or ambulatory surgical unit depending on patient status. Follow-up includes pain management, activity restrictions, wound checks, and outpatient removal of corrective hardware when indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work, time, or intensity substantially exceeds the typical service for the procedure. |