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An open treatment of a humeral supracondylar or transcondylar fracture involves a surgical procedure aimed at correcting fractures located in the distal humerus, specifically above or through the epicondyles. The distal humerus features two prominent bony projections known as the lateral epicondyle and the medial epicondyle. When a fracture occurs just above these epicondyles, it is classified as a supracondylar fracture, whereas a fracture that traverses through the epicondyles is termed a transcondylar fracture. These fractures can extend into the intercondylar region, which includes critical areas such as the trochlea and the olecranon fossa. The trochlea serves as a pulley-like structure that articulates with the ulna, while the olecranon fossa is a posterior depression in the distal humerus that accommodates the olecranon of the ulna during elbow movement. The surgical approach for repairing these fractures typically involves an olecranon osteotomy, where an incision is made over the elbow to access the fractured area. During the procedure, the ulnar nerve is carefully released from the cubital tunnel to prevent nerve damage. The olecranon is then isolated, and a small incision is made into the joint capsule to facilitate access to the fractured surfaces. A probe is utilized to identify the coronoid process, and an osteotomy cut is made just proximal to this structure. The olecranon, along with the intact triceps insertion, is reflected posteriorly, allowing for direct access to the supracondylar and transcondylar joint surfaces. The surgical team then reconstructs the articular surface and secures the fracture fragments to the humeral shaft, employing internal fixation methods such as pins or screws as necessary. This comprehensive approach ensures that the fracture is properly aligned and stabilized, promoting optimal healing and function of the elbow joint.
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The open treatment of humeral supracondylar or transcondylar fractures is indicated for specific conditions and symptoms that necessitate surgical intervention. These include:
The procedure for the open treatment of humeral supracondylar or transcondylar fractures involves several critical steps to ensure effective repair and stabilization of the fracture. The following outlines the procedural steps:
Post-procedure care following the open treatment of humeral supracondylar or transcondylar fractures involves monitoring for complications and ensuring proper recovery. Patients are typically advised to follow specific rehabilitation protocols to restore function and strength to the elbow. This may include physical therapy to improve range of motion and strength. Pain management strategies are also implemented to ensure patient comfort during the recovery phase. Regular follow-up appointments are necessary to assess healing and to make any adjustments to the treatment plan as needed. It is important to monitor for signs of complications such as infection, nerve damage, or improper healing of the fracture.
| Short Descr | TREAT HUMERUS FRACTURE | Medium Descr | OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN | Long Descr | Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; with 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 |
| 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) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 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). | AF | Specialty physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | ET | Emergency services | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2008-01-01 | Changed | Code description changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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