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The procedure described by CPT® Code 24605 involves the treatment of a closed elbow dislocation, which is a condition where the bones of the elbow joint are displaced but the skin remains intact. This procedure requires the administration of anesthesia to ensure the patient's comfort and pain management during the manipulation of the dislocated joint. The physician employs specific techniques to realign the bones of the elbow, which may involve positioning the patient in either a prone or supine position, depending on the type of dislocation. In a posterior dislocation, the patient is typically placed face down, allowing for effective traction and manipulation of the elbow joint. Conversely, for an anterior dislocation, the physician may utilize countertraction techniques to stabilize the humerus while applying traction to the forearm. Following the reduction of the dislocation, the physician assesses the range of motion and checks for any potential neurovascular compromise, ensuring that nerves and blood vessels are not entrapped. A splint may be applied post-procedure to support the elbow during the healing process. This code is specifically designated for cases where anesthesia is utilized, distinguishing it from similar procedures that do not require anesthesia, such as CPT® Code 24600.
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The treatment of a closed elbow dislocation is indicated in cases where the elbow joint has been displaced without any associated open injury. This condition may arise from various traumatic events, such as falls, sports injuries, or accidents, leading to significant pain and functional impairment. The procedure is performed to restore the normal alignment of the elbow joint, alleviate pain, and prevent further complications, such as nerve or vascular injury.
The procedure for treating a closed elbow dislocation involves several critical steps to ensure proper realignment of the joint. The physician begins by positioning the patient appropriately based on the type of dislocation. For a posterior elbow dislocation, the patient is placed in a prone position, with the humerus supported by the examination table. The dislocated elbow is flexed to 90 degrees, allowing the forearm to hang off the table with the fingers pointing downward. The physician then applies manual downward traction to the forearm with one hand while simultaneously grasping the humerus with the other hand, applying downward pressure to the olecranon to facilitate the reduction of the dislocation. Alternatively, if the patient is in a supine position, the affected arm is extended to the side with the elbow slightly flexed. An assistant holds the humerus in place while the physician applies in-line traction to the forearm, maintaining slight flexion and supination of the elbow. In cases of anterior elbow dislocation, the physician relies on an assistant to provide countertraction to the humerus while the physician applies in-line traction to the forearm. After the dislocation is reduced, the physician tests the range of motion of the elbow and reassesses the neurovascular structures to confirm that there is no entrapment of nerves or blood vessels. If necessary, a splint is applied to stabilize the elbow joint during the recovery phase.
After the procedure, the patient is monitored for any immediate complications, including pain management and assessment of neurovascular status. The physician will provide instructions regarding the care of the elbow, including the use of a splint to immobilize the joint and promote healing. Patients are typically advised on activity restrictions to prevent re-injury and may be scheduled for follow-up appointments to monitor recovery and assess the need for physical therapy to restore full range of motion and strength in the elbow. It is essential to ensure that the patient understands the importance of adhering to post-procedure care to facilitate optimal recovery.
| Short Descr | TREAT ELBOW DISLOCATION | Medium Descr | TREATMENT CLOSED ELBOW DISLOCATION REQ ANES | Long Descr | Treatment of closed elbow dislocation; requiring anesthesia | 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 | 145 - Treatment, fracture or dislocation of radius and ulna |
| 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | 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) | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | 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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