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Percutaneous skeletal fixation of a supracondylar or transcondylar humeral fracture, with or without intercondylar extension, is a minimally invasive surgical procedure aimed at stabilizing specific types of fractures in the distal humerus. The distal humerus features two prominent bony projections known as the lateral and medial epicondyles. A supracondylar fracture occurs just above these epicondyles, while a transcondylar fracture extends through them, potentially involving the intercondylar region, which includes critical structures such as the trochlea and olecranon fossa. This procedure is indicated when these fractures occur, as they can significantly impact the function of the elbow and arm. Prior to the fixation, imaging studies, such as radiographs, are performed to confirm the presence and extent of the fracture. The procedure involves the manual reduction of the fracture fragments, ensuring they are realigned to their normal anatomical position. The ulnar nerve, which runs close to the fracture site, is carefully located and protected during the procedure, sometimes necessitating a small incision to facilitate this. The stabilization of the fracture is achieved through the insertion of percutaneous pins or K-wires, which are strategically placed to maintain the alignment of the bone fragments. The use of imaging is critical throughout the procedure to verify both the reduction of the fracture and the correct positioning of the pins. Finally, a long arm cast is applied to provide additional support and immobilization during the healing process.
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The procedure is indicated for the following conditions:
The procedure involves several critical steps to ensure proper fixation of the fracture:
Post-procedure care involves monitoring the patient for any signs of complications, such as infection or improper healing. The long arm cast is typically left in place for a specified duration to ensure adequate immobilization of the fracture site. Follow-up appointments are necessary to assess the healing process and to determine when the pins can be removed, if applicable. Patients may also require physical therapy to regain strength and range of motion in the affected arm after the cast is removed.
| Short Descr | TREAT HUMERUS FRACTURE | Medium Descr | PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX | Long Descr | Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension | 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) | 1 - Statutory 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 | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 148 - Other fracture and dislocation procedure |
| 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). | 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. | 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | 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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| Pre-1990 | Added | Code added. |
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