Basics of Joint replacement procedures
Joint replacement procedure are very common in old age patient. With growing age the bone density decreases and hence joint problems increases. In most of the case joint replacement procedure help in treatment problems like arthritis, osteoarthritis etc. Medical coders has lot of confusion in coding joint replacement or arthroplasty procedure.
To code the arthroplasty procedures, coders have to check the below things in the medical report.
- Procedure objective (replacement or revision of joint)
- Joint invovled with laterality
- Surface of joint being treated (acetabular, femoral, tibial)
- Type of Approach (Percutaneous, Open, endoscopic)
- Devices used (metal, polyethylene, ceramic)
- Other details of procedure (cemented, uncemented)
Read also: Joint Replacement coding guide for knee, hip and shoulder joint
Wrist Arthroplasty coding
Wrist joint replacement codes includes cpt code 25332, 25441-25449. Arthroplasty procedure can differ in technique and component parts depending on the presenting problem. The wrist, also called the carpus, is the region between the distal forearm and the hand. It consists of the distal radius and ulna (bones of the forearm), eight small carpal bones arranged in two rows (proximal and distal), and the proximal metacarpal bones of the hand, which radiate out from the wrist. The bones are connected to each other by a complex series of ligaments.
Read also: Coding Guide for Arthrocentesis CPT codes for joints
Description of CPT code 25332, 25441-25449
In this exam , the physician performs an arthroplasty of the wrist. The physician makes a straight, dorsal, longitudinal incision centered over the wrist from the middle of the third metacarpal proximally. Skin and subcutaneous tissues are elevated off the fascia and retinaculum. The retinaculum over the fourth dorsal compartment is incised longitudinally and elevated medially and laterally. The extensor pollicis longus is freed, retracted radially, and left in the rerouted position at the end of the procedure. A longitudinal incision is made in the capsule. A capsular periosteal flap is elevated through the dorsal radioulnar ligaments. The distal radius is excised, as is the distal ulna if it is dislocated or severely involved. A cut is made through the hamate, capitate, trapezoid, and distal scapho-trapezoid area. The carpus is removed.
The medullary canal of the radius is reamed. A fine awl is used to penetrate the base of the capitate and the shaft of the third metacarpal. The medullary canal of this bone is reamed. If using a double-stemmed component, an additional canal is prepared in the second metacarpal. Appropriate short canals are prepared in the carpal bones. With the wrist in 10 to 20 degree extension, the capsular-periosteal sleeves are repaired over the prosthesis. The extensor retinaculum may be used to reinforce the capsule, or may be repaired anatomically. The skin is closed over a deep and a superficial suction drain.
25332 Arthroplasty, wrist, with or without interposition, with or without external or internal fixation
25442 distal ulna
25443 scaphoid carpal (navicular)
25444 lunate
25445 trapezium
25446 distal radius and partial or entire carpus (total wrist)
25447 Arthroplasty, interposition, intercarpal or carpometacarpal joints
(For wrist arthroplasty, use CPT code 25332)
25449 Revision of arthroplasty, including removal of implant, wrist joint
Codes 25441-25446 describe procedures that include excision of the bone(s) named in the code descriptor and their replacement with a prosthetic device. For wrist arthroplasty without replacement with a prosthetic device, CPT code 25332 should be referenced.
CPT Code 25322 may involved different techniques depending on the nature of the presenting problem(s), the patients requirements for activities of daily living, and the surgeons preference. Intercarpal fusion is not included in this procedure and may be reported separately. When performed, harvest of fascia from the patient may be reported separately using either code 20920 or 20922 as appropriate. Internal or external fixation is included, but not both.
Code 25332, Arthroplasty, wrist, with or without interposition, with or without external or internal fixation, describes arthroplasty of the wrist joint as opposed to arthroplasty of the intercarpal or carpometacarpal joints described in code 25447. Each wrist arthroplasty procedure can differ in technique and component parts, depending on the nature of the presenting problem(s), the patients requirements for activities of daily living, and the surgeons preference. The following two examples illustrate this fact. For instance, an arthroplasty may include synovectomy and restoration of the alignment of the radius and carpal bones with temporary internal fixation in order to create a fibrous ankylosis of the joint. Interposition may or may not be utilized.
If performed, interposition is used to maintain the radiocarpal space (the space between the distal radius and the carpal bones) by insertion of native tissues (such as tendon, perichondrium, dorsal retinaculum, fascia lata) or silastic material. In contrast, palmar shelf arthroplasty includes resection of the cartilage and subchondral bone (the bone just beneath the cartilage). The radius is contoured to provide a shelf into which the proximal carpal row can fit. The wrist is reduced on the radius and is temporarily immobilized with a Kirschner wire. The internal fixation is removed and joint motion is started once soft tissue healing is complete.
Read also: Coding guide for lumber puncture CPT codes
Ankle Arthroplasty coding
Total ankle arthroplasty includes cpt code 27700-27703. Ankle arthroplasty is an alternative to ankle arthrodesis (fusion) for the treatment of end-stage ankle osteoarthritis. The physician performs arthroplasty to correct joint problems caused by arthritis. Three portal incisions are made at the front and sides of the ankle. Joint surfaces are smoothed and scar tissues are removed from the joint. Loose cartilage fragments may be removed along with other debridement. The articular surface may be abraded to initiate reparative cartilage growth. If excessive damage is noted, the physician replaces damaged parts of the ankle with a prosthesis and assigned with CPT code 27702. Use CPT code 27703 if a loose component must be revised.
27700 Arthroplasty, ankle;
27702 with implant (total ankle)
27703 revision, total ankle
Elbow Arthroplasty Coding
24361 with distal humeral prosthetic replacement
24362 with implant and fascia lata ligament reconstruction
24363 with distal humerus and proximal ulnar prosthetic replacement (eg, total elbow)
24366 with implant
24371 humeral and ulnar component