# Wrist Arthrodesis with Bone Graft...Help!



## CrysLednum (Aug 5, 2009)

Hi -  I have a problem where my doc performed a wrist arthrodesis and had originally wanted to code 25810 (arthrodesis, with autograft).  He did not do an autograft - but used Hydroset bone substitute.  He does not want to use the Unlisted code that I suggested but rather an arthrodesis code paired with a bone graft code.   I can't find anything that fits this.  Any suggestions? 

So far I was going to use 25800.....

Thanks!


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## mitchellde (Aug 5, 2009)

can you post the op note?  I have a couple of ideas but I need to see the note first.


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## CrysLednum (Aug 6, 2009)

Yes -

_The radius was exposed follwed by the dorsum of the carpus and the dorsum of the third metacarpal.  The distal radius and proximal carpal row were denuded of articular cartilage and burnt down to subchondral bleeding bone.  The insterstices between the midcarpal row as well as the intercarpal capitate, and scaphoid were all taken down with the bur to subchondral bleeding bone.  At this point the antifuse large cylinder graft was slected and prepared appropriately.  A portion of it was introduced betwenn the radius and carpus, between the carpal bones and another between the proximal and distal carpal rows.  Following this, a straight Synthes fusion plate was selected and precontoured to optimally fit the dorsum of the radius and third metacarpal aiming for neutral wrist position in both planes.  The plate was fixed securely to the third metacarpal with 3 bicortical screws and fit securely to the radius with bicortical screws achieving some compression.  Two additional screws were used to fix into the carpus.  These screws were locking screws to prevent shiftting of the carpus.  The additional antifuse graft material was packed into the carpal interstices.  Interaoperative imaging confirmed optimal plate and screw placement...._


thanks for any suggestions!


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## mitchellde (Aug 6, 2009)

I like 25320 or 25332 but I do not totally disagree witht e 25800 code, it just does not account for the prosthetic graft.  However the 25332 does, but does not account for the plate and screws. 25320 accounts for a graft as well as the fixation of the plate and screws.


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## michellelgrd (Aug 20, 2009)

according to the 2009 global service data book preparation and insertion of synthetic bone substitute is included in the global service package for code 25810, it should not be coded


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