CPT® Code 20802

Official Description

Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation

Common Language Description

The procedure described by CPT® Code 20802 refers to the replantation of an arm that has undergone complete amputation. This complex surgical intervention is performed under general anesthesia to ensure the patient's comfort and safety throughout the operation. The process begins with the careful removal of any damaged tissue surrounding the amputation site, which is crucial for promoting healing and reducing the risk of infection. Following this, the ends of the amputated bones are meticulously trimmed to facilitate a more effective rejoining of the skeletal structure. This preparation is essential as it aids in aligning the soft tissues on either side of the wound, which is a critical step in the reattachment process. The surgeon then proceeds to suture together the various anatomical structures, including arteries, veins, nerves, muscles, and tendons, ensuring that blood flow and nerve function can be restored. In cases where there is a lack of skin coverage, a graft is utilized to protect the underlying tissues. Additionally, any exposed nerves, tendons, and joints may require coverage through a free-tissue transfer, which includes its own blood supply via associated arteries and veins. Finally, the amputation site is closed in layers, which is important for proper healing and minimizing scarring. This comprehensive approach underscores the complexity and precision required in performing a complete arm replantation.

1. Indications

The replantation of an arm, as described by CPT® Code 20802, is indicated in cases of complete amputation of the arm. This procedure is typically performed when the amputation occurs due to traumatic injuries, such as accidents or severe lacerations, where the arm is completely severed from the body. The primary goal of this surgical intervention is to restore the functionality and appearance of the arm, allowing for improved quality of life for the patient.

Complete Amputation The procedure is indicated for patients who have experienced a complete amputation of the arm, necessitating surgical reattachment.

2. Procedure

The replantation procedure involves several critical steps to ensure successful attachment and healing of the amputated arm. Initially, the patient is placed under general anesthesia to ensure they remain comfortable and pain-free throughout the surgery.

Step 1: Tissue Preparation The surgeon begins by carefully removing any damaged or necrotic tissue surrounding the amputation site. This step is vital to prevent infection and promote optimal healing conditions.
Step 2: Bone Trimming After the tissue is prepared, the ends of the amputated bones are trimmed. This process is essential for creating a clean surface that can be easily rejoined, facilitating the alignment of the soft tissues.
Step 3: Soft Tissue Reattachment The surgeon then sutures together the various soft tissues, including arteries, veins, nerves, muscles, and tendons. This meticulous reattachment is crucial for restoring blood flow and nerve function to the reattached arm.
Step 4: Grafting In areas where skin coverage is insufficient, a graft is applied to protect the underlying tissues and promote healing.
Step 5: Free-Tissue Transfer For any exposed nerves, tendons, or joints, a free-tissue transfer may be performed. This involves transferring tissue along with its blood supply to ensure adequate coverage and healing.
Step 6: Closure Finally, the amputation site is closed in layers, which is important for minimizing scarring and ensuring proper healing of the surgical site.

3. Post-Procedure

After the replantation procedure, patients typically require close monitoring in a recovery setting to assess the viability of the reattached arm. Post-operative care may include pain management, wound care, and physical therapy to regain function. Patients are advised on signs of complications, such as infection or compromised blood flow, and follow-up appointments are essential to evaluate the healing process and functionality of the reattached arm. The recovery period can vary based on the extent of the injury and the success of the reattachment, necessitating a tailored rehabilitation plan to support the patient's recovery.

Short Descr	REPLANTATION ARM COMPLETE
Medium Descr	REPLANTATION ARM COMPLETE AMPUTATION
Long Descr	Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation
Status Code	Active Code
Global Days	090 - Major Surgery
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)	2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62)	1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Inpatient Procedures, not paid under OPPS
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P3D - Major procedure, orthopedic - other
MUE	1
CCS Clinical Classification	164 - Other OR therapeutic procedures on musculoskeletal system

This is a primary code that can be used with these additional add-on codes.

20702

Add-on Code MPFS Status: Active Code APC N Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure)

GC	This service has been performed in part by a resident under the direction of a teaching physician
LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)