*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.*
Comments
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.*