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Percutaneous skeletal fixation of a humeral epicondylar fracture, whether medial or lateral, is a minimally invasive surgical procedure aimed at stabilizing fractures located at the distal end of the humerus. The epicondyles are bony protrusions on the humerus that serve as attachment points for muscles and ligaments. Fractures of these areas are classified as extra-articular, meaning they do not extend into the joint space, and can significantly impact the function of the elbow and forearm. The procedure begins with a thorough assessment, including obtaining separate radiographs to confirm the presence and extent of the fracture. A neurovascular examination is also conducted to ensure that the surrounding nerves and blood vessels are intact, which is crucial for preventing complications. Once the fracture is confirmed, the fragments are manually manipulated back into their proper anatomical positions. This manipulation is critical for ensuring optimal healing and function post-surgery. The ulnar nerve, which runs close to the medial epicondyle, is carefully located and protected during the procedure, sometimes necessitating a small incision to facilitate this. Following the reduction of the fracture, percutaneous pins or K-wires are inserted to provide stability to the fracture fragments. The use of these fixation devices allows for a less invasive approach, reducing recovery time and minimizing soft tissue damage. The procedure concludes with the application of a long arm cast to immobilize the area and support the healing process.
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The procedure of percutaneous skeletal fixation of a humeral epicondylar fracture is indicated for specific conditions related to the fracture of the humerus. The following are the explicitly provided indications for this procedure:
The procedure for percutaneous skeletal fixation of a humeral epicondylar fracture involves several critical steps, each designed to ensure the successful stabilization of the fracture:
After the procedure, patients are typically monitored for any immediate complications. The long arm cast is applied to immobilize the arm and facilitate healing. Patients may be advised on post-operative care, including keeping the cast dry and monitoring for signs of complications such as increased pain, swelling, or changes in sensation. Follow-up appointments are essential to assess the healing process and to determine when the pins can be removed, if necessary. Rehabilitation exercises may also be recommended to restore function and strength to the affected arm once healing has progressed.
| Short Descr | TREAT HUMERUS FRACTURE | Medium Descr | PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ | Long Descr | Percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral, with 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 | 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) | 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. | 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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| 1994-01-01 | Added | First appearance in code book in 1994. |
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