Humerus (Upper Arm) and Elbow - Netter's Atlas of Surgical Anatomy for CPT® Coding

23616 with proximal humeral prosthetic replacement 23620 Closed treatment of greater humeral tuberosity fracture;

without manipulation 23625 with manipulation

23630 Open treatment of greater humeral tuberosity fracture, includes internal fixation, when performed

23650 Closed treatment of shoulder dislocation, with manipulation; without anesthesia

23655 requiring anesthesia

23660 Open treatment of acute shoulder dislocation

23665 Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation

23670 Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity, includes internal fixation, when performed

23675 Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulation

23680 Open treatment of shoulder dislocation, with surgical or anatomical neck fracture, includes internal fixation, when performed

Manipulation

23700 Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)

Arthrodesis

Coding Atlas

In glenohumeral arthrodesis, the joint is surgically fused and immobilized. Bone grafts may be placed to fix the joint; in other instances, hardware is placed.

23800 Arthrodesis, glenohumeral joint;

23802 with autogenous graft (includes obtaining graft)

FIGURE 2-25. Muscles of the Upper Arm

The biceps and triceps muscles of the upper arm work as antagonistic muscles to bend and straighten the elbow. Antagonistic muscles are muscles that work in opposition to each other, ie, when the triceps contract, the biceps are stretched and the elbow straightens. Conversely, when the biceps contract, the triceps are stretched and the elbow bends. It is because of this push-and-pull action that these and similarly paired muscles are called antagonist muscles.

Coracoacromial ligament Subdeltoid bursa

Intertubercular tendon sheath Deltoid muscle (reflected) Pectoralis major muscle (reflected) Anterior circumflex humeral artery Biceps brachii muscle

Brachial artery (cut) Median nerve (cut) Brachialis muscle

Bicipital aponeurosis Biceps brachii tendon Brachioradialis muscle Pronator teres muscle Flexor carpi

radialis muscle

Acromion Coracoid process

Pectoralis minor tendon (cut) Subscapularis muscle Musculocutaneous nerve (cut) Coracobrachialis muscle Circumflex scapular artery (cut) Teres major muscle

Latissimus dorsi muscle

Biceps brachii tendons (cut)

Short head Long head Coracobrachialis muscle Musculocutaneous nerve

Deltoid muscle (cut)

Brachialis muscle

Tuberosity of ulna Superficial layer

Head of radius Biceps brachii tendon

Radial tuberosity Deep layer Long head

Short head Greater tubercle of humerus Lesser tubercle of humerus

Lateral antebrachial cutaneous nerve

Lateral antebrachial cutaneous nerve Lateral epicondyle of humerus

Lateral intermuscular septum

Medial epicondyle of humerus Medial intermuscular septum Branch to biceps brachii (cut)

64 Moderate sedation ✚Add-on code ^Modifier 51 exempt #Resequenced code

Musculoskeletal System

Netter’s Atlas of Surgical Anatomy for CPT Coding

24076 Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); less than 5 cm

# 24073 5 cm or greater

24077 Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area; less than 5 cm

24079 5 cm or greater

24100 Arthrotomy, elbow; with synovial biopsy only

24101 with joint exploration, with or without biopsy, with or without removal of loose or foreign body

24102 with synovectomy 24105 Excision, olecranon bursa

24110 Excision or curettage of bone cyst or benign tumor, humerus;

24115 with autograft (includes obtaining graft) 24116 with allograft

24120 Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process;

24125 with autograft (includes obtaining graft) 24126 with allograft

24130 Excision, radial head

24134 Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus

24136 Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck

24138 Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process

24140 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), humerus 24145 Partial excision (craterization, saucerization, or

diaphysectomy) bone (eg, osteomyelitis), radial head or neck

24147 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), olecranon process

24149 Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure)

24150 Radical resection of tumor, shaft or distal humerus 24152 Radical resection of tumor, radial head or neck 24155 Resection of elbow joint (arthrectomy)

Introduction or Removal

Coding Atlas

When a contrast material is injected into any structure in the elbow as part of a separately reported radiographic study, the injection service is reported with code 24220.

For arthrocentesis or needling of joint or bursa, code 20605 is used. For injection for tennis elbow, see code 20550.

24160 Removal of prosthesis, includes debridement and synovectomy when performed; humeral and ulnar components

24164 radial head

24200 Removal of foreign body, upper arm or elbow area;

subcutaneous

24201 deep (subfascial or intramuscular) 24220 Injection procedure for elbow arthrography

Repair, Revision, and/or Reconstruction

Coding Atlas

The elbow is a joint of three bones: humerus, ulna, and radius. In total elbow arthroplasty, defective parts of the humerus and ulna are replaced with a hinged prosthesis.

24300 Manipulation, elbow, under anesthesia

24301 Muscle or tendon transfer, any type, upper arm or elbow, single (excluding 24320-24331)

24305 Tendon lengthening, upper arm or elbow, each tendon 24310 Tenotomy, open, elbow to shoulder, each tendon 24320 Tenoplasty, with muscle transfer, with or without free

graft, elbow to shoulder, single (Seddon-Brookes type procedure)

24330 Flexor-plasty, elbow (eg, Steindler type advancement);

24331 with extensor advancement 24332 Tenolysis, triceps

24340 Tenodesis of biceps tendon at elbow (separate procedure)

24341 Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff)

24342 Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft

24343 Repair lateral collateral ligament, elbow, with local tissue

Netter’s Atlas of Surgical Anatomy for CPT Coding

Musculoskeletal System

24076—24343

FIGURE 2-26. Ligaments of the Elbow

Ligaments are dense regular connective tissues that connect bones to bones, usually around a joint.

In the elbow, the ulnar collateral ligament (UCL) and the lateral collateral ligament (LCL) connect the humerus to the ulna and work to stabilize the elbow. The UCL, also called the medial collateral ligament, can become frayed, stretched, or torn while performing sports activities that involve throwing. This damage may lead to a total rupture of the UCL.

Right elbow

Anterior view

Joint capsule Lateral epicondyle Radial collateral ligament Annular ligament of radius

Biceps brachii tendon

Humerus

Medial epicondyle

Ulnar collateral ligament

Insertion of brachialis muscle

Oblique cord Radius Ulna

Humerus Joint capsule

Radial collateral ligament Annular ligament of radius

Biceps brachii tendon

Humerus Joint capsule

Ulnar collateral ligament Annular ligament of radius Biceps brachii tendon

Oblique cord Radius

Ulna

In 90° flexion: Lateral view In 90° flexion: Medial view

Humerus Joint capsule (cut edge)

Fat pads Synovial membrane

Articular cartilage

Humerus

Opened joint:

Posterior view Subcutaneous olecranon bursa

Triceps brachii tendon Triceps

brachii tendon

Sub-cutaneous olecranon bursa

Opened joint:

Anterior view

Ulna Ulna Radius

Radius

66 Moderate sedation ✚Add-on code ^Modifier 51 exempt #Resequenced code

Musculoskeletal System

Netter’s Atlas of Surgical Anatomy for CPT Coding

24344 Reconstruction lateral collateral ligament, elbow, with tendon graft (includes harvesting of graft)

24345 Repair medial collateral ligament, elbow, with local tissue

24346 Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)

24357 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer’s elbow); percutaneous 24358 debridement, soft tissue and/or bone, open 24359 debridement, soft tissue and/or bone, open with

tendon repair or reattachment

24360 Arthroplasty, elbow; with membrane (eg, fascial) 24361 with distal humeral prosthetic replacement 24362 with implant and fascia lata ligament reconstruction 24363 with distal humerus and proximal ulnar prosthetic

replacement (eg, total elbow) 24365 Arthroplasty, radial head;

24366 with implant

24370 Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component 24371 humeral and ulnar component

24400 Osteotomy, humerus, with or without internal fixation 24410 Multiple osteotomies with realignment on intramedullary

rod, humeral shaft (Sofield type procedure)

24420 Osteoplasty, humerus (eg, shortening or lengthening) (excluding 64876)

24430 Repair of nonunion or malunion, humerus; without graft (eg, compression technique)

24435 with iliac or other autograft (includes obtaining graft) 24470 Hemiepiphyseal arrest (eg, cubitus varus or valgus, distal

humerus)

24495 Decompression fasciotomy, forearm, with brachial artery exploration

24498 Prophylactic treatment (nailing, pinning, plating or wiring), with or without methylmethacrylate, humeral shaft

Fracture and/or Dislocation

Coding Atlas

Codes for reporting fractures and dislocations are classified by the type of reduction and stabilization required. The type of fracture does not necessarily correspond to the type of treatment; a closed fracture may receive open treatment. Dislocations can occur in conjunction with fractures. Percutaneous skeletal fixation describes the insertion of pins through the skin and into the bone fragments to secure the bones’

positions. This is done without direct visualization of the bone. Internal fixation describes the application of pins, nails, or other hardware secured to the bone. External fixation describes multiple pins placed through bone cortex both proximal and distal to the fracture. The pins are attached to an external fixator.

24500 Closed treatment of humeral shaft fracture; without manipulation

24505 with manipulation, with or without skeletal traction 24515 Open treatment of humeral shaft fracture with plate/

screws, with or without cerclage

24516 Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws

24530 Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; without manipulation

24535 with manipulation, with or without skin or skeletal traction

24538 Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension

24545 Open treatment of humeral supracondylar or

transcondylar fracture, includes internal fixation, when performed; without intercondylar extension

24546 with intercondylar extension

24560 Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation

24565 with manipulation

24566 Percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral, with manipulation

24575 Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performed 24576 Closed treatment of humeral condylar fracture, medial or

lateral; without manipulation 24577 with manipulation

Netter’s Atlas of Surgical Anatomy for CPT Coding

Musculoskeletal System

24344—24577

FIGURE 2-27. Bones of the Elbow

The radius and ulna form the elbow joint along with the humerus. The radius, or radial bone, is located on the same side of the wrist as the thumb and articulates with the rounded capitulum of the humerus. It is shorter than the ulna but thicker. At its proximal end, the ulna’s olecranon articulates with the distal humerus at the olecranon fossa.

Right elbow

Humerus Humerus

Condyle Medial Lateral Lateral

supracondylar ridge Radial fossa Lateral epicondyle

Capitulum Head Neck Tuberosity Radius

In extension: Anterior view Ulna

Tuberosity

Radial notch of ulna Coronoid process

Trochlea

Medial epicondyle Coronoid

fossa Medial

supracondylar ridge

Lateral epicondyle Olecranon

fossa

Olecranon Head Neck Tuberosity

Radius Ulna

In extension: Posterior view

Humerus Radius Humerus

In extension: Lateral view Ulna In extension: Medial view

Humerus

Lateral epicondyle Capitulum

Head Neck

Tuberosity

Humerus Medial epicondyle

Capitulum Trochlea Head Neck Tuberosity Radius

Radial notch Ulna Coronoid process Trochlear notch Olecranon

In 90° flexion: Lateral view

Tuberosity

Coronoid process Trochlear notch

Olecranon In 90° flexion: Medial view Groove for

ulnar nerve

of ulna

Sublime tubercle

68 Moderate sedation ✚Add-on code ^Modifier 51 exempt #Resequenced code

Musculoskeletal System

Netter’s Atlas of Surgical Anatomy for CPT Coding

24579 Open treatment of humeral condylar fracture, medial or lateral, includes internal fixation, when performed 24582 Percutaneous skeletal fixation of humeral condylar

fracture, medial or lateral, with manipulation 24586 Open treatment of periarticular fracture and/or

dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius);

24587 with implant arthroplasty

24600 Treatment of closed elbow dislocation; without anesthesia

24605 requiring anesthesia

24615 Open treatment of acute or chronic elbow dislocation 24620 Closed treatment of Monteggia type of fracture

dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulation

24635 Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation, when performed

24640 Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation

24650 Closed treatment of radial head or neck fracture; without manipulation

24655 with manipulation

24665 Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed;

24666 with radial head prosthetic replacement 24670 Closed treatment of ulnar fracture, proximal end (eg,

olecranon or coronoid process[es]); without manipulation 24675 with manipulation

24685 Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when performed

Arthrodesis

Coding Atlas

In elbow joint arthrodesis, the joint is surgically fused and immobilized. Bone grafts may be placed to fix the joint; otherwise, hardware is placed.

24800 Arthrodesis, elbow joint; local

24802 with autogenous graft (includes obtaining graft)

Amputation

Coding Atlas

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.

24900 Amputation, arm through humerus; with primary closure 24920 open, circular (guillotine)

24925 secondary closure or scar revision 24930 re-amputation

24931 with implant

24935 Stump elongation, upper extremity

24940 Cineplasty, upper extremity, complete procedure

Forearm and Wrist

Incision

Coding Atlas

Decompression fasciotomy treats compartment

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