How To Use CPT Code 24363

CPT code 24363 describes the procedure of arthroplasty for the elbow joint, specifically involving the replacement of the distal humerus and proximal ulnar with a prosthetic implant. 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 24363?

CPT 24363 is used to describe the surgical procedure of arthroplasty for the elbow joint. It involves the replacement of the distal humerus (upper arm bone) and proximal ulnar (forearm bone) with a prosthetic implant. This code is used when a provider performs a total elbow arthroplasty, utilizing a prosthetic implant to reconstruct or replace the joint.

2. Official Description

The official description of CPT code 24363 is: ‘Arthroplasty, elbow with distal humerus and proximal ulnar prosthetic replacement (eg, total elbow).’ This code specifically refers to the surgical procedure of replacing the distal humerus and proximal ulnar with a prosthetic implant for the elbow joint.

3. Procedure

During the procedure described by CPT 24363, the provider repairs the elbow joint by replacing the distal humerus and proximal ulnar with a prosthetic implant. The steps involved in this procedure include:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes a longitudinal curved incision over the protruded area, the medial condyle, toward the midline of the elbow.
3. The ulnar nerve is exposed, and the triceps and extensor mechanism are elevated to facilitate extension from the olecranon.
4. The provider exposes the elbow joint and releases the synovium and capsule from the humerus.
5. The proximal ulna and distal humerus are cut, and a total elbow arthroplasty is performed.
6. The provider positions the elbow prosthesis and inserts the final components using bone cement.
7. Hemostasis is achieved, and the triceps tendon is reattached to the proximal ulna.
8. The area is closed in layers.

4. Qualifying circumstances

CPT 24363 is performed on patients who require the replacement of the distal humerus and proximal ulnar with a prosthetic implant due to elbow joint dysfunction or damage. This procedure is typically indicated for conditions such as severe arthritis, traumatic injuries, or failed previous elbow surgeries. The decision to perform arthroplasty and use CPT 24363 is made by the provider based on the patient’s clinical presentation and diagnostic findings.

5. When to use CPT code 24363

CPT code 24363 should be used when a provider performs a total elbow arthroplasty, involving the replacement of the distal humerus and proximal ulnar with a prosthetic implant. This code is specific to the procedure described and should not be used for other types of elbow surgeries or interventions.

6. Documentation requirements

To support a claim for CPT 24363, the provider must document the following information:

• Patient’s diagnosis or condition necessitating the total elbow arthroplasty
• Details of the procedure performed, including the replacement of the distal humerus and proximal ulnar with a prosthetic implant
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures or interventions performed during the same session
• Any complications or unexpected findings encountered during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 24363, ensure that the procedure performed aligns with the description of the code. It is important to accurately document the replacement of the distal humerus and proximal ulnar with a prosthetic implant. CPT code 24363 should not be reported if the provider performs a revision of a total elbow implant, as this would require a different code (such as 24370 or 24371).

8. Historical information

CPT 24363 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 24363

There are several similar codes to CPT 24363 that describe different procedures involving the repair, revision, and reconstruction of the humerus and elbow. These codes include:

• CPT 24362: Arthroplasty, elbow with implant and fascia lata ligament reconstruction
• CPT 24370: Revision of total elbow arthroplasty; including debridement, synovectomy, and capsulectomy
• CPT 24371: Revision of total elbow arthroplasty; including debridement, synovectomy, capsulectomy, and exchange of humeral and/or ulnar component
• CPT 24375: Revision of total elbow arthroplasty; including debridement, synovectomy, capsulectomy, and exchange of humeral and/or ulnar component with allograft
• CPT 24376: Revision of total elbow arthroplasty; including debridement, synovectomy, capsulectomy, and exchange of humeral and/or ulnar component with autograft

9. Examples

1. A patient with severe rheumatoid arthritis undergoes a total elbow arthroplasty, with the distal humerus and proximal ulnar replaced with a prosthetic implant.
2. An individual sustains a traumatic injury to the elbow joint, resulting in significant damage. The provider performs a total elbow arthroplasty to replace the distal humerus and proximal ulnar with a prosthetic implant.
3. A patient with a history of failed previous elbow surgeries requires a total elbow arthroplasty. The provider replaces the distal humerus and proximal ulnar with a prosthetic implant to restore joint function.
4. An individual with advanced osteoarthritis of the elbow undergoes a total elbow arthroplasty, with the distal humerus and proximal ulnar replaced with a prosthetic implant.