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Closed treatment of a medial or lateral epicondylar fracture of the humerus involves a non-invasive approach to manage fractures located at the bony projections known as the medial and lateral epicondyles, which are situated at the distal end of the humerus. These types of fractures are classified as extra-articular, meaning they occur outside of the joint space and do not extend into the joint itself. The procedure is specifically indicated for nondisplaced fractures, where the bone fragments remain in their normal anatomical position and do not require any manipulation to realign them. Prior to the treatment, radiographs, or X-rays, are obtained to confirm the presence of the fracture and to assess its characteristics. A thorough neurovascular examination is also conducted to ensure that the nerves and blood vessels surrounding the fracture site are intact and functioning properly. Following the evaluation, the arm is immobilized using a long arm posterior splint, sugar tong splint, or a long arm cast to provide stability and support during the healing process. This method of treatment is essential for promoting proper recovery while minimizing the risk of complications associated with the fracture.
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The closed treatment of a humeral epicondylar fracture, whether medial or lateral, is indicated for specific conditions related to the fracture type. The following indications are explicitly recognized for this procedure:
The closed treatment of a humeral epicondylar fracture involves several key procedural steps that ensure effective management of the injury. The following steps outline the process:
After the closed treatment procedure, the patient is advised on post-procedure care to ensure optimal recovery. The immobilization device, whether a splint or cast, should remain in place for the duration recommended by the physician, typically until follow-up imaging confirms healing. Patients are instructed to monitor for any signs of complications, such as increased pain, swelling, or changes in sensation, which may indicate issues with the neurovascular status. Follow-up appointments are essential to assess the healing process and to determine when it is safe to begin rehabilitation exercises to restore range of motion and strength in the affected arm.
| Short Descr | TREAT HUMERUS FRACTURE | Medium Descr | CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ | Long Descr | Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation | 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 | Procedure or Service, Multiple Reduction Applies | 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) | P6B - Minor procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 148 - Other fracture and dislocation procedure |
| 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. | 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. | 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.) | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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