Tenolysis is a surgical procedure to remove adhesions that interfere with flexion of the fingers. Tenodesis is the
B. Coronal section: Dorsal view
Radius Lunate Wrist (radiocarpal) joint
Scaphoid Midcarpal joint
Trapezoid Trapezium Carpometacarpal joint Intermetacarpal joints
Ulna
Distal radioulnar joint Articular disk of wrist joint Meniscus
Interosseous intercarpal ligaments
Triquetrum Hamate Capitate Metacarpal bones
4 5 2 3
1 FIGURE 2-30. Carpal and Wrist Bones
The wrist contains eight carpal bones organized into two groups: proximal and distal. The proximal bones (scaphoid, lunate, triquetrum, and pisiform) have no tendon inserts, but instead move according to the mechanical forces of surrounding bones. The distal bones (trapezium, trapezoid, capitate, and hamate) are linked by ligaments to each other and to the five metacarpal bones, creating five carpometacarpal (CMC) joints. The CMC of the thumb is also called the trapezoid- metacarpal (TMC) joint.
Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code © 2015 American Medical Association 75
Netter’s Atlas of Surgical Anatomy for CPT Coding
Musculoskeletal System
Lateral view of Colles fracture demonstrates characteristic silver fork deformity with dorsal and proximal displacement of distal fragment. Note dorsal instead of normal volar slope of articular surface of distal radius.
Dorsal view shows radial deviation of hand with ulnar prominence of styloid process of ulna and decrease or reverse of normal radial slope of articular surface of distal radius
Fractures of distal ends of both radius and ulna (uncommon) produce deformity identical to Colles fracture of distal radius, and treatment is same.
FIGURE 2-31. Colles Fracture
A Colles fracture, a fracture of the distal radius, is the most common fracture of the arm. It typically occurs when a person falls onto his or her outstretched arm. A Colles fracture is within an inch from the distal end of the radius. The fracture may extend into the wrist joint (intra-articular) or may include more than one break site (comminuted).
76 Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code
Musculoskeletal System
Netter’s Atlas of Surgical Anatomy for CPT Coding25606 Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation
25607 Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation
25608 Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments
25609 with internal fixation of 3 or more fragments 25622 Closed treatment of carpal scaphoid (navicular) fracture;
without manipulation 25624 with manipulation
25628 Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when performed
25630 Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulation, each bone
25635 with manipulation, each bone
25645 Open treatment of carpal bone fracture (other than carpal scaphoid [navicular]), each bone
25650 Closed treatment of ulnar styloid fracture
25651 Percutaneous skeletal fixation of ulnar styloid fracture 25652 Open treatment of ulnar styloid fracture
25660 Closed treatment of radiocarpal or intercarpal dislocation, 1 or more bones, with manipulation 25670 Open treatment of radiocarpal or intercarpal dislocation,
1 or more bones
25671 Percutaneous skeletal fixation of distal radioulnar dislocation
25675 Closed treatment of distal radioulnar dislocation with manipulation
25676 Open treatment of distal radioulnar dislocation, acute or chronic
25680 Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation
25685 Open treatment of trans-scaphoperilunar type of fracture dislocation
25690 Closed treatment of lunate dislocation, with manipulation 25695 Open treatment of lunate dislocation
Arthrodesis
Coding Atlas
Wrist arthrodesis is typically performed to reduce pain in a patient with arthritic joints, eg, scapholunate advanced
collapse (SLAC), a common pattern of degenerative arthritis. In SLAC, ligament injury is followed by collapse of the radial side of the wrist. Arthrodesis of the wrist may be complete (codes 25800-25810) or partial (codes 25820-25830).
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) 25830 Arthrodesis, distal radioulnar joint with segmental
resection of ulna, with or without bone graft (eg, Sauve- Kapandji procedure)
Amputation
Coding Atlas
In a Krukenberg procedure, the radius and ulna are separated, and a pincer-like grasp is created from the opposable bones that retain muscle attachments and are enclosed in skin. A guillotine amputation creates a flat wound across the limb. It does not provide skin for adequate closure. Guillotine amputation is typically performed in emergent situations and is followed by wound monitoring for disease prior to a second surgery for revision and flap.
25900 Amputation, forearm, through radius and ulna;
25905 open, circular (guillotine) 25907 secondary closure or scar revision 25909 re-amputation
25915 Krukenberg procedure 25920 Disarticulation through wrist;
25922 secondary closure or scar revision 25924 re-amputation
25927 Transmetacarpal amputation;
25929 secondary closure or scar revision 25931 re-amputation
Netter’s Atlas of Surgical Anatomy for CPT Coding
Musculoskeletal System
25606—25931Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code © 2015 American Medical Association 77
Radial artery and venae comitantes Flexor carpi radialis tendon Tendinous sheath of flexor pollicis longus (radial bursa) Median nerve
Palmaris longus tendon and palmar carpal ligament Transverse carpal ligament (flexor retinaculum) Thenar muscles Proper palmar digital nerves of thumb (Synovial) tendinous sheath of flexor pollicis longus (radial bursa) Probe in 1st lumbrical fascial sheath Common palmar digital artery Proper palmar digital arteries Septa from palmar aponeurosis forming canals
Palmar aponeurosis (reflected)
Ulnar artery with venae comitantes and ulnar nerve Flexor carpi ulnaris tendon
Common flexor sheath (ulnar bursa) containing superficialis and profundus flexor tendons Pisiform
Deep palmar branch of ulnar artery and deep branch of ulnar nerve
Superficial branch of ulnar nerve Palmar digital nerves to 5th finger and medial half of 4th finger
Median nerve
Common flexor sheath (ulnar bursa) Superficial palmar arterial and venous arches
2nd, 3rd, and 4th lumbrical muscles (in fascial sheaths) (Synovial) flexor tendon sheaths of fingers
Anterior (palmar) views
Proper palmar digital nerves of thumb Fascia over adductor pollicis muscle
1st dorsal interosseous muscle Probe in dorsal extension of thenar space deep to adductor pollicis muscle
Thenar space (deep to flexor tendons and 1st lumbrical muscle)
Septum separating thenar from midpalmar space Common palmar digital artery Proper palmar digital arteries and nerves
Ulnar artery and nerve Common palmar digital branches of median nerve (cut) Hypothenar
muscles Common flexor sheath (ulnar bursa) 5th finger (synovial) tendinous sheath Probe in midpalmar space Midpalmar space (deep to flexor tendons and lumbrical muscles) Insertion of
flexor digitorum superficialis tendon Insertion of flexor digitorum profundus tendon
Annular and cruciform parts of fibrous sheath over (synovial) flexor tendon sheaths
Superficial palmar branch of radial artery and recurrent branch of median nerve to thenar muscles FIGURE 2-32. Deep Palmar Soft Tissue
The palmar aponeurosis is a tough membrane overlying the tendons of the palm. Triangular in shape, it is narrow at the wrist and wider at its terminus at the base of the four fingers. The central portion of the palmar aponeurosis is thick and helps form the superficial palmar fascia. The lateral portion covers the muscles of the ball of the thumb.
78 Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code