Orthopedic Coding Alert

Master scenarios like these and arthrodesis coding will improve.

In our last issue (Volume 25, Number 2), we explored the intricacies of wrist arthrodesis coding and showed you how to optimize your limited and complete wrist arthrodesis claims.

In this article, we’ll further your knowledge of wrist arthrodesis with a couple of clinical scenarios, courtesy of Valerie N. Ramirez, MBA, CPC, CPMA, COSC, a coder and auditor working in Chicago.

Remember: These scenarios apply to the wrist arthrodesis code set, which contains the following codes:

• 25800 (Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or intercarpal and/or carpometacarpal joints))
• 25805 (… with sliding graft)
• 25810 (… with iliac or other autograft (includes obtaining graft))
• 25820 (Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal))
• 25825 (… with autograft (includes obtaining graft))

Case 1

Patient chief complaint: Unresolved significant/unbearable pain in the right wrist, swelling, and stiffness

Physician treatment plan: Physician has treated this patient previously for severe primary osteoarthritis in all areas of the right wrist joint. Initial diagnosis was made previously via the culmination of the PA, lateral and oblique x-ray imaging of the right wrist along with finding in exam and symptomology. Patient has previously worn a splint, taken over the counter NSAIDs, and received a corticosteroid injection in the past year with no relief. Pain is still 10/10 for patient. Provider discusses the option of a complete fusion of the right wrist and patient consents to this care.

Surgery: The orthopedist performs a complete arthrodesis of the right wrist joint with sliding bone graft.

Coding: For this encounter, Ramirez says you should report:

• 25805 for the arthrodesis.
• Modifier RT (Right side) appended to 25805 to indicate the laterality of the surgery.
• M19.031 (Primary osteoarthritis, right wrist) appended to 25805 to represent the patient’s wrist injury.

Case 2

Patient chief complaint: Pain, tenderness, difficulty with weight bearing.

Physician treatment plan: Physician has treated this patient previously for SLAC in the left wrist joint. Initial diagnosis was made previously via the culmination of the PA, lateral and oblique xray imaging of the left wrist along with finding in exam and symptomology. Patient has previously worn a splint, taken over the counter NSAIDs, and received a corticosteroid injection in the past year with minimal relief. Patient wishes to have pain relief but does not want to lose full mobility within the joint, therefore the provider discusses the option of a limited fusion of the left wrist and patient consents to this plan of care.

Surgery: The orthopedist performs a limited arthrodesis of the left wrist joint with autograft.

Coding: For this encounter, Ramirez says you should report:

• 25825 for the arthrodesis.
• Modifier LT (Left side) appended to 25825 to indicate the laterality of the surgery.
• M25.332 (Other instability, left wrist) appended to 25825 to represent the patient’s wrist injury.