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Resection of carpal trapezium w/internal brace stabilization for thumb base arthritis

  1. Question Resection of carpal trapezium w/internal brace stabilization for thumb base arthritis
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    Hi all,
    I would like an expert opinion on which CPT code is most appropriate for what looks like a "suspension version" of a CMC arthroplasty.

    Per op report:
    "...A marked amount of arthritis at the trapezial
    carpometacarpal joint was identified. The trapezium was
    osteotomized in 3 places with an osteotome, and the bone was
    removed in fragments completely. The wound was irrigated with
    antibiotic solution. With a 1.5 mm double-stranded labral tape,
    we placed the anchor into the articular base of the second
    metacarpal, strung it across the base of the metacarpal, and
    then placed a second anchor very snugly with the double
    stranded 1.5 mm labral tape into the lateral portion of the
    metacarpal base. This suspended the metacarpal and stabilized
    it completely, with good positioning and no evident subluxing.
    We then irrigated again and placed some antibiotic-soaked
    Gelfoam in the space of the trapezium, did a very tight
    capsular repair with 3-0 Mersilene sutures, mattresses, and
    then closed the skin subcuticular with Monocryl..."

    Would this be a 25447 even though no tendon transfers are mentioned as performed?
    If 25447 is the most appropriate code, should a -52 be appended?

    Aubrey CPC, CRC, COC

  2. #2
    Salt Lake North
    Default It's the code I use
    When treating CMC arthritis I use 25447 even if a tendon transfer is not done. I think it's valid since the tendon transfer would be billed separately. Placing hardware, especially suspension type is very difficult. I think your doc has earned the code. No -52.
    Last edited by Orthocoderpgu; 11-05-2018 at 02:51 PM.

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