Summary & Overview
CPT 21825: Sternal Fracture Repair with Fixation
CPT code 21825 denotes the surgical repair of a sternal fracture with direct access to the fracture site and possible application of fixation hardware. This procedure is a targeted thoracic orthopedic/trauma operation used when nonoperative management is insufficient or when stabilization is required to support chest wall integrity and respiratory mechanics. Nationally, accurate coding of this procedure affects hospital surgical case mix, resource allocation, and billing for complex trauma and thoracic services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and an overview of the metrics and policy considerations often associated with surgical trauma billing. The publication outlines common benchmarking approaches, typical payment and utilization considerations across major payers, and relevant coding nuances to support accurate claim submission.
This summary provides clinicians, coding professionals, and policy analysts with a clear description of the service represented by CPT code 21825, the setting where it is typically performed, and the payer landscape relevant for national benchmarking and administrative planning. Data not available in the input: specific payment rates, associated taxonomies, ICD-10 diagnosis codes, and related codes.
Billing Code Overview
CPT code 21825 describes surgical treatment of a sternal (breastbone) fracture through an incision, with possible placement of a fixation device to stabilize the bone during healing. The procedure involves direct access to the fracture site and may include reduction and internal fixation as clinically indicated.
Service Type: Surgical — Open fracture repair/ORIF of the sternum
Typical Site of Service: Hospital operating room or surgical centers providing inpatient or outpatient thoracic/trauma surgery
Clinical & Coding Specifications
Clinical Context
A 45-year-old male pedestrian struck by a motor vehicle presents to the emergency department with anterior chest pain, localized tenderness over the sternum, crepitus, and respiratory discomfort. CT scan of the chest confirms a displaced midline sternal fracture with subcutaneous emphysema and mild sternal instability. After multidisciplinary trauma evaluation, the orthopaedic or cardiothoracic surgery team elects to perform open reduction and internal fixation of the sternum to restore chest wall stability and reduce pain.
Preoperative workflow includes trauma assessment, imaging (chest CT, x-ray), cardiopulmonary optimization, informed consent, and documentation of fracture displacement and indications for fixation. Intraoperative details include a midline incision over the sternum, debridement of fracture edges, reduction, and application of fixation such as plates and screws or wires. Postoperative care includes pain control, respiratory therapy, wound care, and follow-up imaging to document fixation position and fracture healing. Typical site of service is an inpatient hospital operating room; outpatient ambulatory surgical centers are less common but possible for isolated, stable injuries.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard; no modifier | Rarely used as a placeholder; not typically appended in claims |