How To Use CPT Code 25447

CPT 25447 refers to arthroplasty, interposition, intercarpal or carpometacarpal joints, a surgical procedure primarily performed to treat degenerative arthritis, traumatic injury, or infection in the joint. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 25447 procedures.

1. What is CPT 25447?

CPT 25447 is a medical code used to describe a specific type of surgical procedure known as arthroplasty, interposition, intercarpal or carpometacarpal joints. This procedure is primarily performed to treat patients suffering from degenerative arthritis, traumatic injury, or infection in the joint. The surgery involves ligament reconstruction and tendon interposition (LRTI) or Burton LRTI, where a prosthesis or tendon tissue graft is inserted in the joint to reconstruct the joint and restore its mobility.

2. 25447 CPT code description

The official description of CPT code 25447 is: “Arthroplasty, interposition, intercarpal or carpometacarpal joints.”

3. Procedure

The 25447 procedure involves the following steps:

1. Administration of anesthesia to the patient.
2. A dorsoradial incision is made along the line of the first metacarpal joint and extended medially to the palm.
3. The radial artery is dissected out carefully and protected to avoid injury.
4. The capsule over the trapezium is opened up, and the thenar muscles are elevated from the trapezium and the first metacarpal (MC).
5. The MC at the base of the thumb is excised with a power saw.
6. The interval between the slips of the abductor pollicis longus (APL) is developed.
7. The trapezium is excised, and the bone is carefully removed piecemeal without damaging the flexor carpi radialis (FCR).
8. Drills are used to make holes in the base of the metacarpal.
9. A local graft is harvested from the FCR or APL tendon.
10. Through a longitudinal incision or a series of transverse incisions, the tendon tissue graft is placed.
11. A spacer is made by putting longitudinal weaving sutures in the FCR remnant, rolling the tendon like an anchovy on itself, and inserting it into the trapezium fossa.
12. The EPB tendon is sutured to the shaft of the metacarpal.
13. The metacarpal joint is stabilized, and the wound is closed with sutures and a thumb spica applied.
14. For stage III and IV arthritis, a Swanson silicon prosthesis replacement arthroplasty is performed, where a stem is inserted into the first MC, a spacer in the gap left by the trapezium excision, and a functional elongation of the first MC is performed.

4. Qualifying circumstances

Patients eligible to receive CPT code 25447 services are those suffering from degenerative arthritis, traumatic injury, or infection in the intercarpal or carpometacarpal joints. The procedure is typically recommended when conservative treatments, such as medication, physical therapy, or splinting, have failed to provide adequate relief or when the patient’s condition has significantly deteriorated, affecting their daily activities and quality of life.

5. When to use CPT code 25447

It is appropriate to bill the 25447 CPT code when a patient undergoes arthroplasty, interposition, intercarpal or carpometacarpal joints, to treat degenerative arthritis, traumatic injury, or infection in the joint. The procedure should be performed by a qualified surgeon, and the patient’s medical records should clearly indicate the necessity of the surgery based on their diagnosis and the failure of conservative treatments.

6. Documentation requirements

To support a claim for CPT 25447, the following information needs to be documented:

• Patient’s medical history, including previous treatments and their outcomes.
• Physical examination findings, including the severity of joint pain, swelling, and limited range of motion.
• Diagnostic imaging results, such as X-rays or MRI, confirming the diagnosis and the extent of joint damage.
• A detailed description of the surgical procedure, including the type of anesthesia used, incisions made, grafts harvested, and the specific techniques employed during the surgery.
• Postoperative care instructions and follow-up appointments.

7. Billing guidelines

When billing for CPT code 25447, it is essential to follow the specific guidelines and rules set by the payer. Some tips for billing this code include:

• Ensure that the patient’s medical records contain all the necessary documentation to support the claim, as mentioned in the documentation requirements section.
• Verify the patient’s insurance coverage and obtain any required pre-authorizations before performing the procedure.
• Use the appropriate modifiers, if necessary, to indicate any special circumstances related to the procedure, such as bilateral surgery or staged procedures.
• Stay up-to-date with any changes in coding guidelines or payer policies related to CPT 25447.

8. Historical information

CPT 25447 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 25447

Five similar codes to CPT 25447 and how they differentiate from CPT 25447 are:

• CPT 25332: This code refers to arthroplasty, wrist, with or without interposition, which is a different joint than the intercarpal or carpometacarpal joints.
• CPT 25440: This code is for arthroplasty, radial head, with or without prosthetic replacement, which involves a different joint and may include a prosthetic replacement.
• CPT 25442: This code describes arthroplasty, distal radioulnar joint, with or without interposition, which is a different joint than the intercarpal or carpometacarpal joints.
• CPT 25445: This code is for arthroplasty, elbow, with prosthetic replacement, which involves a different joint and includes a prosthetic replacement.
• CPT 25446: This code refers to arthroplasty, elbow, with distal humeral and proximal ulnar prosthetic replacement (total elbow), which is a different joint and includes both distal humeral and proximal ulnar prosthetic replacements.

10. Examples

Here are 10 detailed examples of CPT code 25447 procedures:

1. A 55-year-old patient with severe osteoarthritis in the carpometacarpal joint of the thumb undergoes arthroplasty with tendon interposition.
2. A 45-year-old patient with a traumatic injury to the intercarpal joint undergoes arthroplasty with ligament reconstruction and tendon interposition.
3. A 60-year-old patient with advanced degenerative arthritis in the carpometacarpal joint undergoes arthroplasty with a Swanson silicon prosthesis replacement.
4. A 50-year-old patient with a history of infection in the intercarpal joint undergoes arthroplasty with ligament reconstruction and tendon interposition.
5. A 65-year-old patient with severe pain and limited range of motion in the carpometacarpal joint due to arthritis undergoes arthroplasty with tendon interposition.
6. A 40-year-old patient with a history of multiple wrist fractures and subsequent arthritis in the intercarpal joint undergoes arthroplasty with ligament reconstruction and tendon interposition.
7. A 70-year-old patient with stage IV arthritis in the carpometacarpal joint undergoes arthroplasty with a Swanson silicon prosthesis replacement.
8. A 48-year-old patient with a history of rheumatoid arthritis affecting the intercarpal joint undergoes arthroplasty with ligament reconstruction and tendon interposition.
9. A 62-year-old patient with severe pain and deformity in the carpometacarpal joint due to osteoarthritis undergoes arthroplasty with tendon interposition.
10. A 52-year-old patient with a history of wrist dislocations and subsequent arthritis in the intercarpal joint undergoes arthroplasty with ligament reconstruction and tendon interposition.