How To Use CPT Code 25446

CPT 25446 describes a surgical procedure that involves the replacement of the radial head on the lower part of the arm and the carpal bones of the wrist with artificial prostheses. 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 25446?

CPT 25446 is a code used to describe a surgical procedure in which the provider replaces the radial head on the lower part of the arm and the carpal bones of the wrist with artificial prostheses. This procedure is performed to treat conditions that affect the wrist joint and require the replacement of these specific anatomical structures.

2. Official Description

The official description of CPT code 25446 is: ‘Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (total wrist).’ This code specifically refers to the surgical procedure that involves the replacement of the radial head and carpal bones with artificial prostheses.

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider makes a longitudinal curved incision over the dorsum (back) of the hand and wrist area.
3. The provider retracts blood vessels and nerve tissues to prevent damage.
4. The provider excises the joint capsule and exposes the bony surface of the joint.
5. The provider accesses the lower end of the radius by incising ligaments above it.
6. The provider excises the heads of the radius and ulna and replaces the radial head with an artificial substitute.
7. The provider may remove all or a few carpal bones and replaces them with prostheses.
8. The provider realigns the radial prosthesis with the carpal implant and ensures stability and smooth movement of the replaced joint.
9. The provider sutures the ligaments and capsule back around the joint.
10. The provider closes the incision in layers and applies a splint for immobilization.

4. Qualifying circumstances

CPT 25446 is performed on patients who have conditions that require the replacement of the radial head and carpal bones with artificial prostheses. These conditions may include severe wrist joint damage, fractures, or other disorders that affect the functionality of the wrist. The procedure is typically performed by a qualified healthcare professional who specializes in orthopedic surgery.

5. When to use CPT code 25446

CPT code 25446 should be used when the provider performs the specific surgical procedure of replacing the radial head and carpal bones with artificial prostheses. This code accurately describes the surgical intervention and should be reported for each instance of the procedure performed.

6. Documentation requirements

To support a claim for CPT 25446, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for the surgical procedure
• Details of the surgical technique used, including the specific prostheses utilized
• Date of the procedure
• Any additional procedures performed during the same surgical session
• Any complications or unexpected findings during the procedure
• Post-operative care instructions and follow-up plans
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 25446, ensure that the procedure performed aligns with the description of the code. The provider should be a qualified healthcare professional with expertise in orthopedic surgery. It is important to follow the specific guidelines provided by the payer regarding the appropriate use of this code and any associated modifiers. Additionally, it is essential to accurately document the procedure and any necessary supporting documentation to ensure proper reimbursement.

8. Historical information

CPT 25446 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. Examples

1. A patient with severe wrist joint damage undergoes arthroplasty with prosthetic replacement of the radial head and carpal bones.
2. An individual with a wrist fracture requires the surgical procedure of replacing the radial head and carpal bones with artificial prostheses.
3. A patient with a degenerative wrist disorder undergoes arthroplasty to restore wrist functionality.
4. An individual with a congenital wrist deformity requires the surgical intervention of replacing the radial head and carpal bones with prostheses.
5. A patient with a wrist injury resulting from trauma undergoes arthroplasty to repair and restore the wrist joint.
6. An individual with a chronic wrist condition undergoes the surgical procedure of replacing the radial head and carpal bones to alleviate pain and improve wrist function.
7. A patient with a wrist disorder that affects daily activities undergoes arthroplasty to restore wrist mobility and functionality.
8. An individual with a wrist joint infection requires the surgical intervention of replacing the radial head and carpal bones with artificial prostheses.
9. A patient with a wrist tumor undergoes arthroplasty to remove the affected bones and replace them with prostheses.
10. An individual with a wrist joint deformity resulting from a previous surgery undergoes the surgical procedure of replacing the radial head and carpal bones to correct the deformity.