How To Use CPT Code 20822

CPT code 20822 describes the replantation of a digit, excluding the thumb, 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 20822?

CPT code 20822 is used to describe the surgical procedure of replanting a digit, excluding the thumb, after it has been completely amputated. This is a major, or open, invasive medical procedure that involves reattaching the amputated body part at the relevant body area.

2. Official Description

The official description of CPT code 20822 is: ‘Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputation.’

3. Procedure

The procedure for CPT code 20822 involves several steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider performs debridement of the wound to prepare the open wound site.
3. The provider evaluates and examines the amputated digit, checking for contamination and assessing its vascular supply.
4. The amputated digit is prepped and debrided to remove dead tissue and any foreign bodies.
5. The provider identifies and tags the arteries, veins, and nerves of the amputated digit using sutures.
6. The amputated digit is brought into the operating field and aligned to the metacarpal on the patient’s body.
7. An arterial clamp is placed on the patient’s hand region to control blood flow during surgery.
8. The provider trims and prepares the metacarpal bones for fixation of the digit bone.
9. Bone plates, screws, pins, and/or Kirschner wires are used to fix the detached bones.
10. The deep flexor sublimis tendon is pulled out from the amputated digit and inserted into the distal tip of the phalange digit bone using K wires and pins for fixation.
11. Other tendons are also fixed to their corresponding ends.
12. The provider repairs the arterial supply by reconnecting the corresponding arteries using microvascular anastomosis.
13. If necessary, vein grafts may be harvested from other sites to repair the amputated body part.
14. The nerves are repaired from one to another.
15. The venous supply is repaired in a similar manner to the arterial supply.
16. The provider checks for proper alignment by forceful extension or flexion of the amputated body part.
17. The skin and open wound are repaired, potentially using skin grafts or flaps from other body areas.
18. The replanted body part is checked for proper alignment.
19. A postoperative X-ray may be obtained for confirmation.

4. Qualifying circumstances

CPT code 20822 is used for the replantation of a digit, excluding the thumb, after complete amputation. This procedure is performed when there is a need to reattach the amputated body part at the relevant body area. It is important to note that this code specifically excludes the thumb, as there is a separate code for thumb replantation.

5. When to use CPT code 20822

CPT code 20822 should be used when a complete amputation of a digit, excluding the thumb, is being replanted. It is important to accurately document the details of the procedure and ensure that the code is used only for the appropriate circumstances.

6. Documentation requirements

To support a claim for CPT code 20822, the following documentation is required:

• Patient’s medical record indicating the complete amputation of the digit
• Details of the replantation procedure, including preoperative evaluation, debridement, fixation of bones and tendons, repair of arterial and venous supply, and skin and wound repair
• Documentation of proper alignment and confirmation of the replanted body part
• Postoperative X-ray, if obtained

7. Billing guidelines

When billing for CPT code 20822, it is important to follow the appropriate billing guidelines. This code should not be reported with separate codes for open reduction, internal fixation, or other types of bone fixation or realignment of arteries. Additionally, all hospital visits and post-discharge office visits related to the replantation procedure, including suture removal, dressing and splint changes, and nerve recovery, are considered part of the postoperative work for this procedure within the 90-day global period.

8. Historical information

CPT code 20822 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes replantation of a completely amputated index finger.
2. A surgeon performs the replantation of a completely amputated middle finger.
3. A patient’s ring finger is replanted after complete amputation.
4. A provider performs the replantation of a completely amputated little finger.
5. A thumb is replanted after complete amputation.
6. A patient undergoes the replantation of a partially amputated index finger.
7. A surgeon performs the replantation of a partially amputated middle finger.
8. A patient’s ring finger is replanted after incomplete amputation.
9. A provider performs the replantation of a partially amputated little finger.
10. A thumb is replanted after incomplete amputation.