How To Use CPT Code 20808

CPT code 20808 describes the replantation of a hand 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 20808?

CPT 20808 is used to describe the surgical procedure of replanting a completely amputated hand. This is a major, invasive procedure that involves reattaching the amputated hand to the relevant body area. The provider performs debridement, evaluates the vascular supply, fixes the bones, repairs the arteries, veins, and nerves, and then repairs the skin and open wound.

2. Official Description

The official description of CPT code 20808 is: ‘Replantation, hand (includes hand through metacarpophalangeal joints), complete amputation.’

3. Procedure

The replantation procedure for a completely amputated hand involves several steps:

1. The provider assesses the patient’s condition and prepares the open wound site through debridement.
2. The amputated hand is evaluated for contamination and the vascular supply is assessed.
3. The hand is prepped and debrided to remove dead tissue and foreign bodies.
4. The arteries, veins, and nerves of the amputated hand are identified, tagged with sutures, and freed.
5. The hand is brought into the operative field and aligned to the patient’s wrist.
6. An arterial clamp is placed on the patient’s forearm to control blood flow during surgery.
7. The provider fixes the metacarpals, the bones of the hand, using bone plates and/or Kirschner wires.
8. The deep tendons are pulled out and fixed with sutures.
9. The provider repairs the arterial supply by reconnecting the corresponding arteries using microvascular anastomosis.
10. If necessary, vein grafts are harvested to repair the amputated hand’s venous supply.
11. The nerves are repaired, ensuring preservation and proper alignment.
12. The veins are repaired in a similar manner, using tagged veins from the amputated body part and the patient’s hand.
13. If needed, vein grafts are harvested for microvascular anastomosis.
14. The provider checks for proper alignment and performs an extensive repair of the skin and open wound.
15. Skin grafts or flaps may be used to repair major skin loss.
16. The replanted hand is checked for proper alignment and a postoperative X-ray is obtained for confirmation.

4. Qualifying circumstances

CPT 20808 is used for patients who have experienced a complete amputation of the hand and require replantation. The procedure is performed by a qualified healthcare professional who has the necessary expertise in hand replantation. The patient must be appropriately prepped and anesthetized for the procedure.

5. When to use CPT code 20808

CPT code 20808 should be used when a complete amputation of the hand is being replanted. It is important to note that this code specifically applies to the replantation of the hand and includes the hand through the metacarpophalangeal joints. If the amputation involves a different body part or a different level of amputation, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT 20808, the healthcare professional must document the following information:

• Patient’s condition and the need for hand replantation
• Evaluation of the amputated hand, including assessment of contamination and vascular supply
• Preparation of the amputated hand, including debridement and removal of dead tissue and foreign bodies
• Details of the surgical procedure, including bone fixation, arterial and venous repairs, nerve repairs, and skin and wound repair
• Postoperative X-ray for confirmation of proper alignment

7. Billing guidelines

When billing for CPT 20808, ensure that the procedure performed is a complete replantation of the hand after amputation. It is important to follow the specific guidelines and documentation requirements for this code. Do not separately report other procedures such as open reduction, internal fixation, or realignment of arteries. All hospital visits and post-discharge office visits related to the replantation procedure within the global period of 90 days are considered part of the postoperative work and should not be separately billed.

8. Historical information

CPT code 20808 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 20808

There are several similar codes to CPT 20808 that describe replantation procedures on the musculoskeletal system. These include CPT codes 20802-20838, which cover various replantation procedures for different body parts and levels of amputation.

9. Examples

1. A patient undergoes replantation of a completely amputated hand after a traumatic injury.
2. A surgeon performs the replantation procedure on a patient whose hand was amputated in an industrial accident.
3. A healthcare professional successfully replants a completely amputated hand that was severed in a car accident.
4. A patient undergoes hand replantation surgery after a severe injury caused by machinery.
5. A surgical team performs the replantation procedure on a patient with a completely amputated hand due to a work-related incident.
6. A provider successfully reattaches a completely amputated hand that was severed in a household accident.
7. A patient undergoes replantation surgery after a traumatic injury resulted in the complete amputation of their hand.
8. A healthcare professional performs the replantation procedure on a patient whose hand was amputated in a sports-related accident.
9. A surgeon successfully replants a completely amputated hand that was severed in a farming accident.
10. A patient undergoes hand replantation surgery after a severe injury caused by a power tool.