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Official Description

Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Closed treatment of a radial head subluxation in a child, commonly known as nursemaid elbow, involves a non-surgical manipulation technique to correct the dislocation of the radial head. This condition typically arises when the radius, one of the bones in the forearm, slips out of its normal position under the annular ligament, often due to a sudden pull on the child's arm, such as when an adult is holding the child's hand and the child suddenly moves away. The procedure is performed on pediatric patients and is characterized by the need for careful manipulation to restore the radial head to its proper alignment. The manipulation is crucial as it alleviates pain and restores function to the elbow joint. In some cases, radiographs may be necessary to rule out any associated fractures before or after the manipulation. The treatment is generally quick, and once the radial head is successfully repositioned, the child is monitored to ensure that normal arm movement is regained.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The closed treatment of radial head subluxation in a child, or nursemaid elbow, is indicated in the following situations:

  • Radial Head Subluxation This procedure is performed when a child presents with a radial head subluxation, characterized by the displacement of the radial head under the annular ligament.
  • Symptoms of Pain The child may exhibit signs of pain in the elbow region, particularly when attempting to move the arm.
  • Limited Range of Motion The child may show an inability or reluctance to use the affected arm, indicating a need for intervention.

2. Procedure

The procedure for closed treatment of radial head subluxation involves several key steps to ensure effective manipulation and restoration of the radial head's position.

  • Step 1: Initial Assessment The clinician begins by assessing the child's condition, including a physical examination to confirm the diagnosis of nursemaid elbow. This may involve observing the child's arm movement and noting any signs of discomfort or pain.
  • Step 2: Immobilization The elbow is then immobilized to prevent further injury during the manipulation process. This step is crucial to stabilize the joint and prepare for the corrective maneuver.
  • Step 3: Palpation With one hand, the clinician palpates the region of the radial head to locate the displaced bone. This tactile assessment helps in understanding the extent of the subluxation and guides the manipulation technique.
  • Step 4: Manipulation Using the other hand, the clinician performs the manipulation to reposition the radial head. This can be achieved through various techniques, such as applying axial compression at the wrist while simultaneously supinating the forearm and flexing the elbow. Alternatively, pronation or extension of the forearm may be employed to facilitate the reduction of the radial head back into its normal position.
  • Step 5: Confirmation of Reduction As the radial head is manipulated back into place, a distinct click or snap may be felt at the radial head, indicating successful reduction. This tactile feedback is an important part of the procedure.
  • Step 6: Observation After the manipulation, the child is observed for a period of 15 to 30 minutes to ensure that normal arm movement is restored. If the child does not demonstrate normal movement during this time, separately reportable radiographs may be obtained to confirm the success of the reduction and rule out any fractures.

3. Post-Procedure

Post-procedure care involves monitoring the child to ensure that normal arm movement is regained. The clinician will observe the child for any signs of discomfort or inability to use the arm. If normal movement is not observed within the specified timeframe, additional imaging may be required to assess the success of the manipulation. Parents or guardians are typically advised on how to monitor the child’s recovery and when to seek further medical attention if necessary. Overall, the procedure is minimally invasive, and most children recover quickly, returning to normal activities shortly after the treatment.

Short Descr TREAT ELBOW DISLOCATION
Medium Descr CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ
Long Descr Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation
Status Code Active Code
Global Days 010 - Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Procedure or Service, Multiple Reduction Applies
ASC Payment Indicator Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P6B - Minor procedures - musculoskeletal
MUE 1
CCS Clinical Classification 145 - Treatment, fracture or dislocation of radius and ulna
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
54 Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number.
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
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