How To Use CPT Code 20805

CPT code 20805 describes the replantation of a forearm after complete amputation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 20805?

CPT 20805 is used to describe the replantation of a forearm after complete amputation. This procedure involves reattaching the amputated forearm to the relevant body area. It is a major, or open, invasive medical procedure that requires the expertise of a qualified healthcare professional.

2. Official Description

The official description of CPT code 20805 is: ‘Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The healthcare provider performs debridement of the wound to prepare the open wound site.
3. The amputated forearm is evaluated for contamination and assessed for its vascular supply.
4. The amputated forearm is prepped and debrided to remove dead tissue and foreign bodies.
5. The arteries, veins, and nerves of the amputated forearm are identified, tagged with sutures, and freed.
6. The amputated forearm is brought into the operating field and aligned to the patient’s body.
7. An arterial clamp is placed on the patient’s forearm to control blood flow during surgery.
8. The bones of the forearm (radius and ulna) are fixed using bone plates and/or wires.
9. The deep tendons are pulled out from both the patient’s body and the amputated forearm and fixed with sutures.
10. The arterial supply is repaired using microvascular anastomosis, reconnecting the corresponding arteries.
11. The nerves are repaired from one to another.
12. The venous supply is repaired in a similar manner, reconnecting the corresponding veins.
13. The skin and open wound are repaired using skin grafts or flaps from other body areas.
14. The replanted forearm is checked for proper alignment and a postoperative X-ray is obtained for confirmation.

4. Qualifying circumstances

CPT 20805 is performed on patients who have experienced a complete amputation of the forearm. The procedure is indicated when there is a possibility of successful replantation and restoration of function. The patient must be evaluated for their vascular supply and overall suitability for the procedure. The healthcare provider must have the necessary expertise and resources to perform the replantation.

5. When to use CPT code 20805

CPT code 20805 should be used when a complete amputation of the forearm is being replanted. It is important to ensure that the procedure meets the criteria outlined in the official description. If the amputation does not involve the complete forearm or if the procedure does not involve replantation, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT 20805, the healthcare provider must document the following information:

• Patient’s diagnosis and indication for replantation
• Details of the procedure, including preoperative evaluation, debridement, fixation of bones and tendons, repair of arterial, venous, and nerve supply, and skin and wound repair
• Date and duration of the procedure
• Postoperative X-ray for confirmation
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 20805, ensure that the procedure meets the criteria outlined in the official description. It is important to accurately document the details of the procedure and provide any necessary supporting documentation. CPT code 20805 should not be reported with other codes for open reduction, internal fixation, or realignment of bones or arteries. All hospital visits and postoperative office visits related to the replantation procedure within the global period should be considered part of the postoperative work and not separately billed.

8. Historical information

CPT code 20805 was added to the Current Procedural Terminology system on January 1, 1990. It was initially removed from the Inpatient Only (IPO) list in 2017 but was later added back to the list in 2022.

9. Similar codes to CPT 20805

There are several similar codes to CPT 20805 that describe replantation procedures on the musculoskeletal system. These include CPT codes 20802, 20803, 20804, 20806, 20808, 20810, 20812, 20814, 20816, 20818, 20820, 20822, 20824, 20826, 20828, 20830, 20832, 20834, 20836, and 20838. Each code represents a specific replantation procedure on different body areas or structures within the musculoskeletal system.

9. Examples

1. A patient undergoes replantation of a forearm after a complete amputation due to a traumatic injury.
2. A healthcare provider performs the replantation of a forearm for a patient who accidentally severed their arm in an industrial accident.
3. A patient undergoes replantation of a forearm after a surgical amputation due to a malignant tumor.
4. A healthcare provider performs the replantation of a forearm for a patient who experienced a complete amputation during a car accident.
5. A patient undergoes replantation of a forearm after a self-inflicted injury.
6. A healthcare provider performs the replantation of a forearm for a patient who suffered a complete amputation during a sporting event.
7. A patient undergoes replantation of a forearm after a severe crush injury.
8. A healthcare provider performs the replantation of a forearm for a patient who experienced a complete amputation during a farming accident.
9. A patient undergoes replantation of a forearm after a surgical amputation to treat a severe infection.
10. A healthcare provider performs the replantation of a forearm for a patient who accidentally severed their arm while operating machinery.