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Official Description

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

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Prophylactic treatment of the humeral shaft is a surgical intervention aimed at preventing fractures in bones that have been compromised due to underlying conditions such as diseases or neoplasms. The humeral shaft, which is the long, cylindrical part of the upper arm bone, can become weakened, making it susceptible to fractures. To address this vulnerability, various techniques are employed, including nailing, pinning, plating, or wiring. These methods are designed to reinforce the structural integrity of the bone. In some cases, methylmethacrylate, a type of bone cement, may be utilized to fill in any defects or voids in the bone, further enhancing stability. The choice of technique is determined based on a thorough radiographic evaluation of the weakened bone, allowing the surgeon to select the most appropriate prophylactic approach. This careful assessment ensures that the selected method effectively supports the bone and minimizes the risk of future fractures.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The prophylactic treatment of the humeral shaft is indicated for patients with weakened bone structures due to various underlying conditions. The following are specific indications for this procedure:

  • Bone Weakness The procedure is performed when the humeral shaft is compromised due to diseases such as osteoporosis or metastatic cancer, which can lead to an increased risk of fractures.
  • Neoplastic Conditions Patients with bone tumors or neoplasms that affect the integrity of the humeral shaft may require prophylactic treatment to prevent fractures.

2. Procedure

The procedure for prophylactic treatment of the humeral shaft involves several key steps, which are detailed below:

  • Evaluation of the Weakened Bone Initially, a thorough radiographic evaluation is conducted to assess the condition of the humeral shaft. This imaging helps determine the extent of the weakness and guides the selection of the most appropriate prophylactic method.
  • Selection of Prophylactic Method Based on the evaluation, the surgeon decides on the best approach to reinforce the bone. Options include nailing, pinning, plating, or wiring, with or without the use of methylmethacrylate.
  • Intramedullary Implant Placement If an intramedullary implant is chosen, the procedure can be performed using either an antegrade or retrograde approach. In the antegrade approach, an incision is made over the proximal humerus, and a hole is drilled to facilitate the insertion of the intramedullary device. Conversely, the retrograde approach involves splitting the distal triceps and drilling a hole in the olecranon process to insert the nail or rod into the intramedullary space.
  • Securing the Implant Once the nail or rod is in place, it is secured with locking screws that are placed distally and proximally to ensure stability. If pins are utilized, they are inserted transcutaneously through the weakened area of the bone.
  • Plating and Wiring Techniques In cases where plating is indicated, the bone is exposed through an open surgical approach, and a plate is affixed to the bone using screws. For wiring, a wire cerclage is wrapped around the bone to provide additional support.
  • Application of Methylmethacrylate If necessary, methylmethacrylate is injected into any bony defects to enhance the structural integrity of the humeral shaft.

3. Post-Procedure

After the prophylactic treatment, patients typically require monitoring for any signs of complications. Post-procedure care may include pain management, physical therapy to restore mobility, and follow-up imaging to assess the stability of the treatment. The expected recovery period can vary based on the individual patient's condition and the specific techniques used during the procedure. Patients are advised to follow their surgeon's instructions regarding activity restrictions and rehabilitation to ensure optimal healing and prevent future fractures.

Short Descr REINFORCE HUMERUS
Medium Descr PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT
Long Descr Prophylactic treatment (nailing, pinning, plating or wiring), with or without methylmethacrylate, humeral shaft
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 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 148 - Other fracture and dislocation 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.
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
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.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
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
CR Catastrophe/disaster related
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)
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
RT Right side (used to identify procedures performed on the right side of the body)
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