# Implant arthroplasty of the capitate



## Ccgerson (Jan 31, 2018)

Has anyone come across this procedure? 

" Proximal row carpectomy with implant arthroplasty of the capitate"

I believe it's fairly new.  None of the wrist hemiarthroplasty codes work for this.  There are codes for lunate, trapezium, and scaphoid. And 25215 for proximal row carpectomy does not cover the arthroplasty.  

 Unlisted?  Or 25446 with modifier 52, since the distal ulna is is not replaced?  

Thank you!
Cindy


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## AlanPechacek (Jan 31, 2018)

You are correct that this is a "new" type of wrist arthroplasty.  There was a previous Forum Query regarding this, but unfortunately I am unable to backtrack and find it.  This procedure involves the *Proximal Row Carpectomy (25215)* and the *placement of a prosthesis that is fixed to the Capitate*, which is one of the distal row carpals.  This makes it a type of "Interposition Arthroplasty" using/placing the prosthesis between the distal radius and the Captitate.  The Codes for "Prosthetic Arthroplasty" of the wrist are from 25441 through 25446.  As 25446 reads, however, the distal radius has to be resected along with partial (Proximal Row Carpectomy) or complete carpectomy, and which is considered a "Total Wrist Arthroplasty," not a "Hemiarthroplasty."  This does not match up with this particular type of Arthroplasty because the distal radius is not removed, just the proximal row of carpals.  All the others of this series replace only one element of the wrist: distal radius, distal ulna, or a single carpal bone, without a "row carpectomy," so these don't work either.

     The procedure in question is a two phase Arthroplasty, the first being the *Proximal Row Carpectomy (25215)* and the second phase of an *"Interposition Arthroplasty" with the* *prosthetic Capitate*.  The surgeon should get credit for all the work done, so I would list the *25215* first, then *26989: Unlisted procedure, wrist*, and pair it with 
*25441: Arthroplasty of the Wrist with Prosthetic replacement*.  I would put *Modifier 51: Multiple Procedures* on the *26989*.

Eventually "the powers that be" will probably designate a code for this new procedure, but don't hold your breath.  This is the best I can do to sort it out.  I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.


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## Ccgerson (Feb 2, 2018)

Thank you.  You've helped answer many of my questions on this forum.  Grateful.


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## squaley (Aug 13, 2019)

Update:
CPT® Assistant. February 2019; Volume 29: Issue 2 Surgery: Musculoskeletal System Question: A physician performs proximal row carpectomy and resurfacing of the capitate (or in some cases, hemi-replacement of the capitate) for severe radiocarpal arthritis from a scaphoid lunate advanced collapse (SLAC) wrist deformity. What is the appropriate code to report proximal row carpectomy with resurfacing of the capitate or hemi-replacement of the capitate? Answer: Code 25215, Carpectomy; all bones of proximal row, should be reported if only proximal row carpectomy is performed. However, report only code 25332, Arthroplasty, wrist, with or without interposition, with or without external or internal fixation, if both proximal row carpectomy and resurfacing of the capitate is performed. Report code 25999, Unlisted procedure, forearm or wrist, if a hemi-replacement of the capitate implant is performed (with or without proximal row carpectomy). The implant procedure is essentially a 'partial' total wrist and there is currently no CPT code to report this procedure.


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