Summary & Overview
CPT 21811: Open Surgical Fixation of One to Three Rib Fractures
CPT code 21811 represents open surgical fixation of one to three fractured ribs, often performed for traumatic chest wall injuries. The procedure may use internal fixation hardware and can include thoracoscopic assistance for improved visualization. Nationally, this code captures definitive surgical management of rib fractures when nonoperative care is insufficient, and it is relevant to trauma, thoracic surgery, and orthopedic service lines.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and common sites of service, plus a summary of payer coverage patterns and benchmarks where available. The publication also outlines common billing modifiers and service-line considerations to support accurate claim submission and policy interpretation.
This summary is designed to help hospitals, surgical practices, and billing teams understand where CPT code 21811 fits in care pathways for rib fracture management, what settings typically perform the procedure, and which payers commonly reimburse it. Data not available in the input is noted where relevant.
Billing Code Overview
CPT code 21811 describes an open surgical repair of rib fractures with internal fixation of one to three ribs. The procedure may include a thoracoscopy to improve visualization during repair. This code covers operative management of traumatic rib fractures using internal fixation techniques.
Service Type: Surgical — Open rib fixation with possible thoracoscopic assistance
Typical Site of Service: Inpatient or outpatient hospital operating room, or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who sustained blunt thoracic trauma from a motor vehicle collision or fall, presenting with severe chest pain, respiratory compromise, and localized chest wall deformity. Initial evaluation in the emergency department includes airway, breathing, circulation assessment, chest radiography and chest computed tomography to evaluate rib fractures, flail chest segments, hemothorax, or pneumothorax. When imaging demonstrates one to three displaced or unstable rib fractures with significant pain, impaired ventilation, or chest wall instability, the trauma or thoracic surgery team evaluates the patient for operative fixation.
Indications for open rib fixation include displaced rib fractures causing respiratory compromise, flail chest, persistent pain refractory to multimodal analgesia, and failure of conservative management. The operative workflow typically includes preoperative optimization, informed consent, general endotracheal anesthesia, single‑lung ventilation or bronchial blockade when needed, possible thoracoscopic assistance for visualization, open exposure of the affected ribs, and internal fixation with plates, screws, or intramedullary devices. Postoperative care focuses on pain control, pulmonary hygiene, chest tube management if placed, and early mobilization. The procedure generally occurs in an operating room; typical sites of service include inpatient hospital OR, ambulatory surgical center when clinically appropriate, or trauma center operating room for acute injuries.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |