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    OpenPayerBilling CodesFracture and/or Dislocation Procedures on the Neck (Soft Tissues) and ThoraxCPT cpt-21813-open-rib-fixation-seven-or-more-ribs
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    CPT 21813: Open Fixation of Seven or More Rib Fractures

    Medicare pays $893 on average nationally for this procedure.

    CPT code 21813 describes open surgical treatment of multiple rib fractures (typically seven or more) with internal fixation, often performed with thoracoscopic assistance; this is a operative chest wall stabilization procedure and the service is surgical fixation of ribs, commonly provided in an inpatient or operating room setting within a hospital or trauma center for patients with traumatic thoracic injury.

    For related coverage guidance, see recent payer policy updates: Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members, Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policy, Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP]).

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 48-year-old male presents to the emergency department after a high-speed motor vehicle collision with severe left-sided chest wall pain, respiratory distress, and visible deformity of the rib cage. Imaging (chest X-ray and CT chest) demonstrates multiple displaced left rib fractures spanning ribs 3 through 9 with a flail chest segment and underlying pulmonary contusion. The trauma team and cardiothoracic surgery consult determine that operative fixation is indicated to stabilize the chest wall, improve ventilation, and reduce pain. The patient is scheduled for open reduction and internal fixation of seven or more ribs with possible video-assisted thoracoscopic surgery (VATS) for intra-thoracic assessment and evacuation of hemothorax.

    Preoperative workflow includes trauma evaluation, airway and respiratory optimization, informed consent documenting risks and benefits of open rib fixation, and anesthesia assessment (general endotracheal anesthesia). Intraoperative activities include thoracoscopic inspection, open exposure of the fracture segments, contouring and application of rib plates/systems to seven or more ribs, hemostasis, chest tube placement as indicated, and postoperative transfer to a monitored setting for pain control and respiratory support. Postoperative care focuses on ventilatory support as needed, chest physiotherapy, pain management, imaging to confirm hardware position, and monitoring for complications such as pneumothorax, hemothorax, infection, or hardware failure.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11012Debridement of extensive chest wall wound; first 20 sq cm or less (large/deep wounds)May be performed prior to or during open rib fixation if soft tissue debridement is required for wound management.
    32608Thoracoscopy, surgical; with diagnostic/therapeutic intervention (eg, evacuation of hemothorax)VATS is commonly performed in conjunction with open rib fixation for visualization and treatment of intrathoracic injury.
    32551Tube thoracostomy, includes connection to drainage system (e.g., chest tube)Chest tube placement is frequently performed during or after rib fixation for pneumothorax/hemothorax management.
    99223Initial hospital care, typically 60 minutes or moreHigher-level inpatient evaluation and management commonly billed for complex postoperative care after major thoracic fixation.
    27635Open treatment of distal fibula fracture, with or without internal fixationNot related — Data not available in the input.

    Note: If a related CPT code list was not provided in the input, common adjunctive codes were selected based on clinical workflow for open rib fixation with thoracoscopic assistance.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    2080P0207X
    207K00000X
    2084P0800X
    207R00000X
    261QD0000X
    332900000X
    207ZP0213X

    Related ICD-10-CM Codes

    17 rows

    ICD-10-CM CodeDescription
    M80.00XAAge-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
    S20.219AContusion of unspecified front wall of thorax, initial encounter
    S20.221AContusion of right back wall of thorax, initial encounter
    S20.229AContusion of unspecified back wall of thorax, initial encounter
    S22.31XAFracture of one rib, right side, initial encounter for closed fracture
    S22.32XAFracture of one rib, left side, initial encounter for closed fracture
    S22.39XAFracture of one rib, unspecified side, initial encounter for closed fracture
    S22.41XAMultiple fractures of ribs, right side, initial encounter for closed fracture
    S22.42XAMultiple fractures of ribs, left side, initial encounter for closed fracture
    S26.00XAUnspecified injury of heart with hemopericardium, initial encounter

    Showing 1–10 of 17

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 3

    10 rows

    PolicyPayerEffective Date
    Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Membersuniverahealthcare2027-01-01
    Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policybcbsvermont2026-12-01
    Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP])Cigna2026-10-15
    Metatarsophalangeal Joint ReplacementCigna2026-10-15
    Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing)univerahealthcare2026-10-15
    Hip Arthroplasty (partial and total hip replacement)univerahealthcare2026-10-15
    Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty)univerahealthcare2026-10-15
    Osteochondral Grafting of the Kneeuniverahealthcare2026-10-15
    Metal-on-Metal Total Hip Resurfacinguniverahealthcare2026-10-15
    Lumbar Fusion (arthrodesis) with decompressionuniverahealthcare2026-10-15

    Related Codes

    CPT-21811-RIB-FRACTURE-OPEN-FIXATION

    CPT 21811: Open Surgical Rib Fixation (1–3 Ribs)

    CPT-21812-OPEN-RIB-FIXATION-WITH-THORACOSCOPY

    CPT 21812: Open Internal Fixation of Multiple Rib Fractures

    CPT-21820-STERNAL-FRACTURE-MANIPULATION

    CPT 21820: Closed Manipulation of Sternal Fracture

    CPT-21825-STERNAL-FRACTURE-OPEN-REPAIR-FIXATION

    CPT 21825: Open Treatment of Sternal Fracture

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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