How To Use CPT Code 25430

CPT 25430 describes the procedure of inserting a vascular pedicle into a carpal bone, such as the Hori procedure. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 25430?

CPT 25430 is used to describe the surgical procedure of inserting a vascular pedicle into a carpal bone, specifically for providing blood supply to dead bone tissue. This procedure involves the implantation of a vein/artery or a bone graft with a live blood supply to restore blood flow to the affected carpal bone.

2. Official Description

The official description of CPT code 25430 is: ‘Insertion of vascular pedicle into carpal bone (eg, Hori procedure).’ This procedure is performed to establish blood supply to a necrotic or avascular carpal bone by inserting a vascularized bone graft or a vascular pedicle into the affected area.

3. Procedure

1. After anesthesia and preparation of the wrist area, the healthcare provider makes an incision in the appropriate compartment of the wrist, typically the 2nd or 3rd extensor compartment.
2. A capsulotomy is performed to access the necrotic or avascular carpal bone.
3. The provider removes the avascular or necrotic bone material and creates a small hole in the affected area.
4. A vascularized bone graft is obtained by tracing and following a branch of the extensor compartment artery or anterior interosseous artery to its origin.
5. The vascular pedicle bone graft is raised and inserted into the prepared space in the necrotic carpal bone.
6. The provider secures the vascular pedicle with small pieces of corticocancellous bone graft or may use a vascular pedicle bone graft fed by the metacarpal artery.
7. The capsule is closed, and the wound is closed in layers in an aseptic manner.

4. Qualifying circumstances

CPT 25430 is performed on patients with a necrotic or avascular carpal bone that requires the restoration of blood supply. This procedure is typically indicated for patients with conditions such as avascular necrosis or other diseases affecting the blood flow to the carpal bone. The procedure must be performed by a qualified healthcare provider with the necessary expertise in vascular pedicle insertion.

5. When to use CPT code 25430

CPT code 25430 should be used when a healthcare provider performs the insertion of a vascular pedicle into a carpal bone to restore blood supply to a necrotic or avascular carpal bone. This code is specific to the Hori procedure or similar techniques.

6. Documentation requirements

To support a claim for CPT 25430, the healthcare provider must document the following information:

• Patient’s diagnosis indicating the need for the procedure
• Details of the procedure performed, including the specific approach and any modifications
• Date of the procedure
• Any additional procedures or techniques used during the surgery
• Any complications or unexpected findings
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 25430, ensure that the procedure was performed by a qualified healthcare provider and that the documentation supports the medical necessity of the procedure. It is important to follow the specific guidelines provided by the payer and use the appropriate modifiers if necessary. Additionally, be aware of any bundling or unbundling issues with other related procedures.

8. Historical information

CPT 25430 was added to the Current Procedural Terminology system on January 1, 2002. The code description was changed on January 1, 2003, from ‘Harii procedure’ to ‘Hori procedure.’ There have been no further updates or changes to the code since then.

9. Examples

1. A patient with avascular necrosis of the carpal bone undergoes the Hori procedure to restore blood supply.
2. A healthcare provider performs the insertion of a vascular pedicle into a carpal bone to treat a patient with a traumatic injury resulting in avascular bone.
3. A patient with a chronic disease affecting the blood flow to the carpal bone undergoes the Hori procedure to prevent further necrosis.
4. A healthcare provider performs the Hori procedure on a patient with a congenital condition causing avascular bone in the carpal area.
5. A patient with a history of radiation therapy develops avascular necrosis of the carpal bone and undergoes the insertion of a vascular pedicle to restore blood supply.
6. A healthcare provider performs the Hori procedure on a patient with a carpal bone infection resulting in avascular necrosis.
7. A patient with a vascular disorder affecting the carpal bone undergoes the Hori procedure to improve blood flow and prevent further complications.
8. A healthcare provider performs the insertion of a vascular pedicle into a carpal bone to treat a patient with a failed previous surgery resulting in avascular bone.
9. A patient with a rare genetic condition causing avascular necrosis of the carpal bone undergoes the Hori procedure to restore blood supply.
10. A healthcare provider performs the Hori procedure on a patient with a severe fracture resulting in avascular bone in the carpal area.