How To Use CPT Code 24160

CPT code 24160 describes the removal of a previously implanted prosthesis from the elbow joint, including debridement and synovectomy if necessary. 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 24160?

CPT 24160 is used to describe the removal of a prosthesis from the elbow joint. This code specifically applies when both the humeral and ulnar components of the prosthesis are being removed. The procedure may also involve debridement and synovectomy to ensure the complete removal of the prosthesis and any associated necrotic tissue.

2. Official Description

The official description of CPT code 24160 is: ‘Removal of prosthesis, includes debridement and synovectomy when performed humeral and ulnar components.’

3. Procedure

The procedure for CPT 24160 involves the following steps:

1. Administer anesthesia to the patient and prepare the surgical site.
2. Create an incision over the area where the prosthesis is implanted, typically using the previous incision or a posterior approach.
3. Reflect (bend back) the layers of skin, subcutaneous tissue, fascia, tendons, and muscles to access the prosthesis.
4. Take precautions to protect the ulnar nerve during the procedure.
5. Debride any necrotic tissue present in the area.
6. Expose the humeral and ulnar components of the prosthesis.
7. If necessary, perform synovectomy to remove inflamed joint tissue and improve visibility of the prosthesis.
8. Remove the prosthesis, along with any cement in the joint, using curettement or debridement if required.
9. Thoroughly wash the wound with saline and antibiotic solution.
10. Close the wound in layers using aseptic techniques.

4. Qualifying circumstances

CPT 24160 is performed when a previously implanted prosthesis in the elbow joint needs to be removed. It is important to note that this code should not be reported if the prosthesis is being removed and replaced during the same surgical session. Additionally, if the removal of hardware from the distal humerus or proximal ulna is being performed, other than the humeral and ulnar prosthesis, CPT code 20680 should be used instead.

5. When to use CPT code 24160

CPT code 24160 should be used when a provider is removing a prosthesis from the elbow joint, specifically the humeral and ulnar components. It is important to ensure that the prosthesis being removed does not require replacement during the same surgical session. If a replacement is necessary, a different code should be used.

6. Documentation requirements

To support a claim for CPT 24160, the following documentation should be included:

• Patient’s medical record should indicate the need for prosthesis removal.
• Details of the procedure, including the specific prosthesis being removed (humeral and ulnar components).
• Date of the procedure and the duration of the surgery.
• Any additional procedures performed during the same surgical session, such as debridement or synovectomy.
• Any complications or unexpected findings during the procedure.
• Post-operative care instructions and follow-up plans.
• Signature of the provider performing the procedure.

7. Billing guidelines

When billing for CPT 24160, it is important to ensure that the procedure meets the specific criteria outlined in the code description. This includes the removal of both the humeral and ulnar components of the prosthesis, as well as any necessary debridement and synovectomy. It is also important to note that CPT code 24160 should not be reported if a prosthesis is being removed and replaced during the same surgical session. Additionally, be aware of any specific guidelines or modifiers that may be required by the payer.

8. Historical information

CPT code 24160 was added to the Current Procedural Terminology system on January 1, 1990. The code was later updated on January 1, 2014, with the description change to ‘Implant removal elbow joint.’

9. Similar codes to CPT 24160

There are several similar codes to CPT 24160 that may be used in different scenarios:

• CPT 24200: Removal of foreign body, elbow (excluding prosthesis)
• CPT 24201: Removal of foreign body, elbow; deep
• CPT 20680: Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
• CPT 24370: Implantation of humeral prosthesis, with or without associated removal of the humeral head or neck
• CPT 24371: Implantation of humeral prosthesis, with or without associated removal of the humeral head or neck; with biological or synthetic bone graft

9. Examples

1. A patient with a previously implanted elbow prosthesis requires removal of both the humeral and ulnar components due to infection.
2. A prosthesis in the elbow joint has become loose, causing pain and limited range of motion. The provider performs a removal procedure to address the issue.
3. Following a traumatic injury, a patient’s elbow prosthesis needs to be removed to assess the extent of damage and plan for further treatment.
4. A patient with a history of complications related to their elbow prosthesis requires removal of the implant to alleviate symptoms and improve overall function.
5. Due to a failed prosthesis, a patient undergoes a removal procedure to prepare for a revision surgery.
6. A patient with a previously implanted elbow prosthesis experiences recurrent dislocations, necessitating the removal of the prosthesis to explore alternative treatment options.
7. Following a successful joint fusion procedure, the provider removes the previously implanted elbow prosthesis.