Re: Question about a Wielby procedure

edited May 2017 in Orthopedics
Look for Tendon interposition and suspensionplasty...that is a Weilby.

Comments

  • 25447 and what suspensionplasty? Confused.
  • edited May 2017
    *Basal joint arthroplastyAnatomy: The basal joint of the thumb is also
    known as the carpometacarpal (CMC) joint. Located at the base of the thumb,
    the basal joint usually moves quite freely to help position the
    thumb. Coding: Arthritis of the basal joint is often treated with an
    arthroplasty. Years ago, the anchovy procedure, as it was called, was
    represented by 25447 (Arthroplasty, interposition, intercarpal or
    carpometacarpal joints), and this code is still used for the treatment of
    basal joint arthritis. If the tendon graft is harvested from a separate
    incision, 20924 (tendon graft, from a distance [eg, palmaris, toe extensor,
    plantaris]) can also be reported. The GSD includes the following procedures
    under code 25447: arthrotomy/synovectomy of wrist or intercarpal joints;
    excision of osteophytes, bone fragments and joint debridement; partial or
    total excision of trapezium or trapezoid; capsular release, repair and/or
    reconstruction; and internal fixation of implant. The harvesting of tendon
    graft through separate skin or fascial incision is excluded from code
    25447.A variation of this procedure adds a sling or suspension aspect. The
    first metacarpal is suspended to the second metacarpal to inhibit the
    proximal migration of the first metacarpal that often occurs after the
    excisional arthroplasty of the first CMC joint. Typically, one half (or
    all) of the flexor carpi radialis (FCR) is used to create the new
    intercarpal ligament between the first and second metacarpals. The transfer
    of the FCR to the base of the first metacarpal is not a part of the basic
    CMC arthroplasty and must be coded separately. Use either 26480 (transfer
    or transplant of tendon, carpometacarpal area or dorsum of hand; without
    free graft, each tendon) or 25310 (tendon transplantation or transfer,
    flexor or extensor, forearm and/or wrist, single; each tendon, as
    appropriate). Modifier 51 would be appended to the secondary procedure in
    either the 25447 + 26480 or 25310 code pairs, according to the January 2005
    CPT Assistant.Now let’s look at some recent questions about coding hand,
    wrist and finger procedures.Implant removalWhat is the difference between
    20680 and 26320?Although 20680 covers the removal of a deep implant (buried
    wire, pin, screw, metal band, nail, rod or plate), the AAOS Coding,
    Coverage and Reimbursement Committee says that code 26320 (removal of
    implant from finger or hand) should be used for removal of a carpal
    prosthesis, carpal screws, or other material inside the wrist
    capsule/joint. This procedure would require capsular or retinacular closure
    plus skin closure. IM rodding of metacarpal bonesWhat CPT code would be
    used to report intramedullary (IM) rodding of the metacarpal bones?If the
    fracture is opened, then the AAOS Coding, Coverage and Reimbusement
    Committee recommends using 22615, the code for open treatment with internal
    fixation. Technically, the IM rod is considered as internal fixation in the
    revised CPT guidelines (at the beginning of the musculoskeletal section).
    If, however, the technique is performed percutaneously and the fracture
    site is not opened, then codes such as 26607 or 26727 may be more
    appropriate.*
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