Anthem Blue Cross Connecticut SURG.00120 Internal Rib Fixation Systems Form


Internal Rib Fixation System for Flail Chest with Dependence on Mechanical Ventilation

Indications

(748405) Is the use of an internal rib fixation system intended for open treatment of flail chest? 
(748406) Is the patient dependent on mechanical ventilation for more than 4 hours per day? 
(748407) Is the ventilator dependency in the absence of other causes such as severe brain injury? 

Internal Rib Fixation System for Other Indications


Contraindications

(748408) Is the internal rib fixation system being used for indications other than open treatment of flail chest? 
Effective Date

06/28/2023

Last Reviewed

05/11/2023

Original Document

  Reference



This document addresses the treatment of rib fracture(s) using an open approach and an internal fixation system. Operative reduction and internal fixation with the use of simple pins, wires or plates, without use of specially designed internal rib fixation devices, is not addressed in this document.

Position Statement

Medically Necessary:

The use of an internal rib fixation system is considered medically necessary for the open treatment of flail chest in individuals dependent (require > 4 hours per day of positive pressure ventilation) on mechanical ventilation in the absence of other causes of ventilator dependency such as severe brain injury.

Investigational and Not Medically Necessary:

The use of an internal rib fixation system is considered investigational and not medically necessary for all other indications.