How To Use CPT Code 25215

CPT 25215 describes the excision of all three carpal bones of the proximal row in the wrist. 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 25215?

CPT 25215 is used to describe the excision of all three carpal bones (scaphoid, lunate, and triquetrum) of the proximal row in the wrist. The proximal row is located closer to the radius and ulna in the wrist area compared to the distal row. This procedure is performed to address certain wrist conditions or injuries that affect the carpal bones in the proximal row.

2. Official Description

The official description of CPT code 25215 is: ‘Excision, carpal bones, proximal row (eg, scaphoid, lunate, triquetrum).’

3. Procedure

During the procedure for CPT 25215, the patient is appropriately prepped and anesthetized. The provider makes an incision on the posterior side of the wrist joint and takes precautions to protect blood vessels and nerves. The joint capsule and carpal bones are incised and opened. The provider then detaches all three carpal bones (scaphoid, lunate, and triquetrum) of the proximal row from the surrounding structures, such as ligaments, tendons, and muscle. The carpal bones are removed one by one. The soft tissue of the excised carpal bones may be attached to nearby bones or used to fill the space left after excision. The wound is irrigated and closed in layers.

4. Qualifying circumstances

CPT 25215 is performed when there is a need to remove all three carpal bones (scaphoid, lunate, and triquetrum) of the proximal row in the wrist. This procedure is typically indicated for certain wrist conditions or injuries that specifically affect the carpal bones in the proximal row. The decision to perform this procedure is made based on the patient’s clinical presentation and diagnostic findings.

5. When to use CPT code 25215

CPT code 25215 should be used when the provider performs the excision of all three carpal bones (scaphoid, lunate, and triquetrum) of the proximal row in the wrist. It is important to ensure that the procedure performed aligns with the official description of the code. If the procedure does not involve the excision of all three carpal bones of the proximal row, a different code should be used to accurately represent the performed procedure.

6. Documentation requirements

To support a claim for CPT 25215, the provider must document the following information:

• Patient’s diagnosis or condition necessitating the excision of the carpal bones
• Details of the procedure, including the incision, detachment, and removal of the carpal bones
• Any additional procedures performed during the same operative session
• Any complications or unexpected findings encountered during the procedure
• Post-operative care instructions or recommendations
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 25215, it is important to ensure that the procedure performed aligns with the official description of the code. The provider should follow the appropriate coding guidelines and modifiers, if applicable, to accurately represent the performed procedure. It is also important to review any specific billing guidelines or requirements from the payer to ensure proper reimbursement.

8. Historical information

CPT 25215 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 25215

There are several similar codes to CPT 25215 that may be used to describe related procedures. These include:

• CPT 25210: Excision, carpal bones, distal row (eg, trapezium, trapezoid, capitate, hamate)
• CPT 25230: Excision, carpal bones, other than proximal or distal row(s), each bone
• CPT 25240: Excision, carpal bones, multiple, with or without pisiform

9. Examples

1. A patient with severe wrist arthritis undergoes CPT 25215 to excise the carpal bones of the proximal row for pain relief and improved joint function.
2. An individual with a traumatic wrist injury requires CPT 25215 to remove the damaged carpal bones of the proximal row and restore wrist stability.
3. A patient with a rare congenital condition undergoes CPT 25215 to address abnormal carpal bone development in the proximal row.
4. A professional athlete with a sports-related wrist injury requires CPT 25215 to remove the carpal bones of the proximal row and facilitate rehabilitation and return to play.
5. A patient with a chronic wrist condition undergoes CPT 25215 as part of a comprehensive treatment plan to alleviate pain and improve wrist function.
6. An individual with a tumor in the wrist area requires CPT 25215 to remove the affected carpal bones of the proximal row and address the underlying pathology.
7. A patient with a degenerative joint disease undergoes CPT 25215 to excise the carpal bones of the proximal row and alleviate symptoms of pain and limited mobility.
8. An individual with a wrist infection requires CPT 25215 to remove the infected carpal bones of the proximal row and prevent further spread of the infection.
9. A patient with a failed previous wrist surgery undergoes CPT 25215 to address complications and improve overall wrist function.
10. An individual with a wrist deformity undergoes CPT 25215 to correct the alignment and structure of the carpal bones in the proximal row.