Orthopedic Coding Alert

Check for graft before choosing code.

Patients who report to the orthopedist with wrist issues sometimes require wrist arthrodesis to fix their diagnosed problem. Coders who report encounters with these patients need a firm grip on a few basics in order to succeed with each claim.

The basics: For wrist arthrodesis, you’ll need to make a pair of decisions that will affect coding: the completeness of the procedure, and whether or not the orthopedist performed a bone graft during the surgery.

Go inside the numbers for a look at the intricacies of wrist arthrodesis coding.

Answer Limited, Complete Question First

When you’re coding wrist arthrodesis services, you’ll have to choose between the following codes, depending on the scope of the procedure.

For complete wrist arthrodesis, you’ll choose from the following codes, depending on encounter specifics:

• 25800 — Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or intercarpal and/or carpometacarpal joints))
• 25805 — … with sliding graft
• 25810 — … with iliac or other autograft (includes obtaining graft).

According to Heidi Stout, BA, CPC, COSC, PCS, CCS-P, with Coder on Call, Inc., in Milltown, New Jersey, complete wrist arthrodesis “fuses the radius, carpal, and metacarpal bones. No motion of the wrist is retained.”

For partial wrist arthrodesis, you’ll choose from the following codes, depending on encounter specifics:

• 25820 — … limited, without bone graft (eg, intercarpal or radiocarpal)
• 25825 — … with autograft (includes obtaining graft).

Stout explains that a “limited, or partial, wrist arthrodesis allows some retained motion.” Also, you might want to keep an eye out for these fusion techniques, which Stout says are indicative or limited wrist arthrodesis:

• scaphocapitate,
• radiolunate,
• scaphotrapeziotrapezoid (STT), and
• four-corner (hamate, capitate, lunate, triquitrum).

I.D. Bone Graft Before Reporting 25805, 25810

When your provider performs a complete wrist arthrodesis, she’ll also sometimes perform a bone graft. When this occurs, you’ll report 25810 for an autograft, and 25805 for a sliding bone graft.

The autograft, which Stout says is the most common graft for wrist arthrodesis, occurs when the surgeon fuses wrist joints together using a bone graft harvested from the patient.

A sliding graft “involves harvesting bone from the distal radius and sliding it into slots — but in the index and long fingers metacarpals,” says Stout. You might see sliding grafts employed by your surgeon, but you might not. Sliding grafts are pretty rare, and Stout says she has never seen an operative report in which the surgeon employs this technique.

Osteoarthritis, Instability Often Drive Patients to Arthrodesis

There are a large number of potential diagnoses that a patient might have that require wrist arthrodesis; you’ll need to check your payers’ policies on these surgeries in order to nail down an approved payer list for each procedure.

However, there are a few conditions that orthopedic coders will see more often than others on wrist arthrodesis claims. According to Stout, wrist arthrodesis procedures are often performed for patients with the following diagnoses:

• Osteoarthritis: M19.03- (Primary osteoarthritis, wrist).
• SLAC (scapholunate advanced collapse) wrist: M25.33- (Other instability, wrist). “If SLAC wrist has caused arthritis, add code M19.23- [Secondary osteoarthritis, wrist],” relays Stout.
• Kienbock’s disease: M93.1 (Kienbock’s disease of adults).
• Deformity: M21.- (Other acquired deformities of limbs).
• Trauma: (Various codes, depending on encounter specifics.)