Basic of CPT code 25447 & 25448
In 2025, we have a new CPT code in Musculoskeletal System in Surgery. New CPT code 25448 is used for intercarpal or carpometacarpal joint arthroplasty with suspension, including transfer or transplant of tendon with interposition, when performed. CPT Code 25447 was editorially revised and is now the parent code to CPT 25448. Let us checkout the description and guidelines for these codes.
Description of CPT code 25447 & 25448
25447 Arthroplasty, intercarpal or carpometacarpal joints; interposition (eg, tendon)
25448 suspension, including transfer or transplant of tendon, with interposition, when performed
Note : Do not report 25448 in conjunction with 25447 and vice versa
The physician performs a surgery called interposition or suspension arthroplasty on the joints of the hand, specifically the intercarpal or carpometacarpal joints.
For CPT code 25447 (interposition arthroplasty on a non-thumb joint), the physician makes an incision over the joint. They cut the joint capsule and dislocate the joint to expose the bones. The physician removes part of the bone (either the metacarpal or carpal bone) and shapes the remaining bone to fit a prosthesis. A piece of tendon or fascia is used to replace the excised bone. A Kirschner wire may be inserted temporarily to stabilize the joint. After the procedure, the capsule and skin are stitched closed.
For interposition arthroplasty on the thumb joint, the incision is made on the first metacarpal and extends to the trapezioscaphoid joint. The surrounding muscles and joint capsules are cut, and the trapezium bone (and sometimes part of the first metacarpal) is removed. A piece of tendon or fascia is placed in the space where the bone was removed. A Kirschner wire may be used temporarily to stabilize the joint. The muscles, joint capsules, and skin are stitched closed. This procedure is also known as ligament reconstruction and tendon interposition (LRTI).
For CPT code 25448 (suspension arthroplasty), a modified technique is used. The physician creates a tunnel in the bone of the first metacarpal. They split the flexor carpi radialis tendon near the second metacarpal, pull it through the tunnel, and secure it in place with sutures. The capsule and skin are stitched closed. This procedure includes transferring the tendon and using it as interposition when performed.