# CMC interpostional arthroplasty



## scooter1 (Nov 1, 2012)

My doctor states he did a CMC interpostion arthroplasty with trapezial excision and 
STT interpostion arthroplasty.
The report reads:

Dissection was carried out at the base of the 1st metacarpal as well as around the trapezium. Using an oscillating saw, a four-quadrant cut was made into the trapezium.
using a rongeur, the trapezium was fully excised.  There was severe osteophytic spurring on the STT joint identified and moderate arthritic changes of the CMC joint present. With the trapezium fully excised, the STT joint at the scaphotrapezoid level was visualized.  There was narrowing and a sclerotic appearance to the articulation. Using a bone saw, a wafer of bone was removed at the level of the STT joint from the proximal aspect of the trapezoid.

I am thinking  25447 and 25210.  But not sure.  Would really appreciate some guidance.
Thank you


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## OCD_coder (Nov 1, 2012)

You would only bill the 25447 as the 25210 bundles and it is typical to remove one of the carpal bones in an interposition arthroplasty.  Sometimes a surgeon will take tendon segment and wrap it around one of the bones creating a natural arthroplasty.

25210 Partial or total excision of trapezium *or* trapezoid.  You can bill this code with a mod-59 if both carpal bones are removed.

Also included per the AAOS Global Service Data:
-arthrotomy/synovectomy of carpometacarpal or intercarpal joint
-excision of osteophytes or bone fragments, with joint debridement
-internal fixation


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