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The CPT® Code 24371 refers to the procedure known as the revision of total elbow arthroplasty, which is a surgical intervention aimed at correcting issues related to previously implanted elbow joint components. This procedure is typically indicated in cases where there is component loosening, joint instability, infection, or periprosthetic fracture. During the revision surgery, the surgeon reopens the old incision over the elbow joint to access the internal structures. The ulnar nerve, which runs along the inner side of the elbow, is carefully identified and protected to prevent injury during the procedure. The surgical approach involves exposing the ulnar component of the prosthesis, followed by the removal of any loose bone cement that may be compromising the stability of the implant. The radial nerve is also identified and safeguarded during the operation. The humeral component, which is the part of the prosthesis that replaces the upper arm bone, is similarly exposed, and any loose cement is removed. The surgeon evaluates both the ulnar and humeral components to determine if they need to be replaced or repositioned. In cases where infection or necrotic bone is present, debridement of the affected tissues is performed to ensure a healthy environment for the new or repositioned components. The components are then secured in place using allograft bone, cerclage wires, and/or bone cement, and are locked together with a pin to create a stable hinged prosthetic joint. After the components are secured, the surgeon reattaches ligaments and tendons, medializes the triceps muscle, and creates a subcutaneous pocket for the ulnar nerve to ensure it is properly positioned. Finally, the fascia and skin are closed in layers, and the arm is placed in a splint to facilitate recovery. This code is specifically used when both the humeral and ulnar components are revised, distinguishing it from CPT® Code 24370, which is used when only one of the components requires revision.
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The revision of total elbow arthroplasty, as described by CPT® Code 24371, is indicated for several specific conditions that may compromise the functionality and stability of the elbow joint. These indications include:
The procedure for the revision of total elbow arthroplasty involves several critical steps to ensure the successful replacement or repositioning of the elbow components. The process begins with the surgeon making an incision over the existing surgical site to access the elbow joint. The soft tissues surrounding the joint are carefully dissected to expose the ulnar nerve, which is identified and protected to prevent any nerve damage during the procedure. Once the ulnar nerve is safeguarded, the ulnar component of the prosthesis is exposed, and the subperiosteum along the ulna is dissected to a point just beyond the tip of the implant. At this stage, any loose bone cement is meticulously removed to prepare the site for the new or repositioned components. The radial nerve is also identified and protected during this process. Following this, the humeral component is exposed, and any loose cement is similarly removed. The surgeon evaluates both the ulnar and humeral components to determine if they need to be replaced or can be repositioned. If there is evidence of infection or necrotic bone, the surgeon performs debridement to remove any unhealthy tissue. Once the evaluation is complete, the components may be exchanged for new ones, or the existing components may be repositioned as necessary. The humeral and ulnar components are then tamped into place and tested for stability. To secure the components, the surgeon may use allograft bone, cerclage wires, and/or bone cement. The components are locked together with a pin to create a stable hinged prosthetic joint. After securing the components, the surgeon reattaches the ligaments and tendons, medializes the triceps muscle, and creates a subcutaneous pocket for the ulnar nerve, ensuring it is positioned between subcutaneous fat and fascia near the medial epicondyle. Finally, the fascia and skin are closed in layers, and the arm is fully extended and placed in a splint to support the healing process.
Post-procedure care following the revision of total elbow arthroplasty is crucial for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or excessive swelling. Pain management is an essential aspect of post-operative care, and patients may be prescribed analgesics to manage discomfort. Rehabilitation often begins shortly after surgery, with physical therapy focusing on restoring range of motion and strength in the elbow joint. Patients are advised to follow specific instructions regarding activity restrictions and the use of the splint to protect the joint during the initial healing phase. Regular follow-up appointments are necessary to assess the healing process and ensure that the components are functioning as intended.
| Short Descr | REVISE RECONST ELBOW JOINT | Medium Descr | REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT | Long Descr | Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component | 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) | 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 | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 154 - Arthroplasty other than hip or knee |
This is a primary code that can be used with these additional add-on codes.
| 20704 | Add-on Code MPFS Status: Active Code APC N Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure) | 20705 | Add-on Code MPFS Status: Active Code APC N Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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) |
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