CPT® Code 20150

1. Indications

The excision of an epiphyseal bar, as described by CPT® Code 20150, is indicated for patients experiencing a partial epiphyseal arrest. This condition can lead to significant growth discrepancies in long bones, particularly in the femur and tibia. The procedure is typically recommended when there is a need to restore normal growth patterns in these bones, especially in pediatric patients who have substantial growth potential remaining.

• Partial Epiphyseal Arrest This condition occurs when the growth plate is partially obstructed, leading to abnormal bone growth.
• Significant Growth Remaining The procedure is indicated in patients who still have considerable growth potential in their long bones.

2. Procedure

The procedure begins with the patient being placed under general anesthesia to ensure they are completely unconscious and free from pain. Once the patient is adequately anesthetized, they are positioned supine on the operating table, allowing the surgeon optimal access to the affected limb. The surgeon then makes an incision through the fascia to reach the epiphyseal bar. Care is taken to identify and preserve surrounding structures, including muscles and nerves, to minimize the risk of complications. The next step involves the careful excision of the epiphyseal bar, which may include removing a portion of the injured epiphyseal plate. This excision is crucial as it aims to restore normal growth patterns in the bone. In some cases, an autogenous soft tissue graft may be harvested from the same fascial incision to fill the void left by the excised tissue, promoting healing and supporting bone growth. After the excision and any necessary grafting, the surgical site is meticulously closed with sutures. Finally, the area is dressed with compressive bandages to reduce the risk of hematoma formation, and the affected limb is immobilized to ensure stability during the recovery process.

• Anesthesia The patient is placed under general anesthesia for the procedure.
• Positioning The patient is positioned supine to provide access to the affected limb.
• Incision An incision is made through the fascia to access the epiphyseal bar.
• Excision The surgeon excises the epiphyseal bar and potentially part of the injured epiphyseal plate.
• Grafting An autogenous soft tissue graft may be used to fill the void left by the excision.
• Closure The surgical site is closed with sutures and dressed with compressive bandages.
• Immobilization The affected limb is immobilized to support healing.

3. Post-Procedure

After the excision of the epiphyseal bar, patients typically require a period of hospitalization for recovery, which can last several weeks. During this time, healthcare providers will monitor the surgical site for any signs of complications, such as infection or hematoma formation. Pain management is an essential aspect of post-operative care, and patients may be prescribed analgesics to manage discomfort. Physical therapy may be initiated to promote mobility and strengthen the affected limb, although the extent and timing of rehabilitation will depend on the individual patient's recovery progress. It is crucial for patients to follow their surgeon's post-operative instructions closely, including any recommendations for activity restrictions and follow-up appointments to assess healing and growth progress.