Orthopedic Coding Alert

Hand surgeons who document thumb carpometa-carpal stabilization" " "Eaton procedure" or "LRTI" in their notes often stump orthopedic coders who cannot locate any such descriptors in CPT. Although orthopedists may refer to the surgery differently 25447 (Arthroplasty interposition intercarpal or carpometacarpal joints) fits the bill for all of these nicknames.

Also referred to as CMC LRTI (carpometacarpal ligament reconstruction tendon interposition) thumb arthroplasty allows the surgeon to eliminate the arthritic joint but preserve the joint's function.

The first step in coding these procedures is to familiarize yourself with the term that your orthopedist uses in his or her documentation to describe the surgery because two physicians rarely document it identically.

"Our surgeon usually refers to arthroplasty with interposition to the CMC joint or LRTI " says Jacqui Jones office manager at Klamath Orthopedic and Sports Medicine Clinic in Klamath Falls Ore. "When I see that I know to apply 25447 to the claim."

Once you identify that the surgeon performed CMC resection arthroplasty however the operative report will also list several additional procedures such as "removal of trapezium and placement of slip from abductor pollicis longus through the extensor carpi radialis tendon and back onto the abductor pollicis longus tendon along with pin fixation of the shaft of the first metacarpal into the scaphoid ..."

Although the surgeon may seem to have gone above and beyond the work included in 25447 this code actually covers all of these additional procedures so you should not report them separately.

Because trapezium excision is included in this procedure it would be inappropriate to report 25210 (Carpectomy; one bone) separately although this is a common coding error.

Global Service Data for Orthopaedic Surgery (published by the American Academy of Orthopaedic Surgeons [AAOS]) states that the following procedures are included in 25447: arthrotomy/synovectomy of wrist of intercarpal joints; excision of osteophytes bone fragments and joint debridement; partial or total excision of trapezium or trapezoid; capsular release repair and/or reconstruction; and internal fixation of implant.

If the surgeon obtains the patient's tendon graft through a separate incision you should report 20924 (Tendon graft from a distance [e.g. palmaris toe extensor plantaris]).

Add Other Procedures a La Carte

In some cases the surgeon will perform a fusion to stabilize the metacarpophalangeal thumb joint with the CMC joint arthroplasty. If this is the case report 26850 (Arthrodesis metacarpophalangeal joint with or without internal fixation) with modifier -51 (Multiple procedures) appended along with 25447.

If the surgeon performed capsulodesis for stabilization instead of a fusion the appropriate CPT code would be 26516 (Capsulodesis metacarpophalangeal joint; single digit) also billed with modifier -51.