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



## aknapp1117 (Nov 5, 2018)

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?

Thanks, 
Aubrey CPC, CRC, COC


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## Orthocoderpgu (Nov 5, 2018)

*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.


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