CPT® Code 0814T

Official Description

Percutaneous injection of calcium-based biodegradable osteoconductive material, proximal femur, including imaging guidance, unilateral

Common Language Description

The procedure described by CPT® Code 0814T involves the percutaneous injection of a calcium-based biodegradable osteoconductive material into the proximal femur. This technique is primarily aimed at reinforcing the structural integrity of the proximal femur, which is particularly beneficial in preventing hip fractures, especially among elderly patients who may be susceptible to such injuries due to low-impact trauma. The procedure is often indicated for patients who have already sustained a hip fracture, as it can provide additional support to the affected area. In some cases, the injection may also be performed on the contralateral side during the surgical intervention for the fracture, thereby strengthening the other hip to mitigate the risk of future fractures. The process begins with a small incision to access the femoral cortex, followed by the insertion of a tissue protector and an obturator. A guide pin is then advanced to the apex of the femoral neck, facilitating the subsequent steps of drilling and injection. The use of imaging guidance, specifically fluoroscopy, ensures accurate placement of the osteoconductive material, which is injected in a continuous manner until it reaches the lateral cortex. This procedure is time-sensitive, requiring the injection to be completed within five minutes of mixing the material, and concludes with a thorough check for any leakage at the injection site before the instruments are removed.

1. Indications

The procedure is indicated for the following conditions:

Hip Fracture The injection is performed to strengthen the proximal femur in patients who have already experienced a hip fracture.
Preventive Measure It is utilized to help prevent future hip fractures, particularly in elderly patients who may be at risk due to low-impact trauma.
Contralateral Support The procedure may be indicated for the contralateral side during fracture surgery to provide additional support to the other hip.

2. Procedure

The procedure consists of several detailed steps to ensure the effective injection of the calcium-based biodegradable osteoconductive material into the proximal femur:

Step 1: Incision and Access A small incision is made to access the femoral cortex, allowing for the introduction of necessary instruments into the area.
Step 2: Insertion of Tissue Protector and Obturator A tissue protector is inserted to safeguard the surrounding tissues, followed by the insertion of an obturator to facilitate the next steps of the procedure.
Step 3: Guide Pin Advancement A guide pin is advanced to the apex of the femoral neck, providing a precise point for subsequent drilling.
Step 4: Cannulated Drill Insertion The centering obturator is removed, and a cannulated drill is inserted over the guide pin, extending to the lateral femoral cortex.
Step 5: Drilling Drilling is performed until reaching the proximal trabecular intersection, after which both the drill and tissue protector are removed.
Step 6: Site Preparation A probing debrider is utilized to mark the margins of the site that requires strengthening, followed by suction irrigation to prepare the area for injection.
Step 7: Mixing and Injection of Material The calcium-based biodegradable osteoconductive material is mixed and drawn into a syringe. The injection cannula is then inserted, and the material is injected in a continuous manner from proximal to distal under fluoroscopy until it reaches the lateral cortex.
Step 8: Completion and Leakage Check The injection must be completed within five minutes of mixing the material. After the injection, the site is checked for any leakage, and all instruments are carefully removed.

3. Post-Procedure

Post-procedure care involves monitoring the injection site for any signs of leakage or complications. Patients may be advised on activity restrictions to ensure proper healing and to avoid undue stress on the proximal femur. Follow-up imaging may be necessary to assess the effectiveness of the injection and the integrity of the femur. Additionally, healthcare providers should provide instructions on pain management and any other supportive care needed during the recovery period.

Short Descr	PRQ NJX BIOD OSTEO MATRL FEM
Medium Descr	PERQ NJX CALCIUM BIOD OSTEOCONDUCTIVE MATRL FEM
Long Descr	Percutaneous injection of calcium-based biodegradable osteoconductive material, proximal femur, including imaging guidance, unilateral
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Non-Covered Service, not paid under OPPS
Berenson-Eggers TOS (BETOS)	none
MUE	1