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Arthrodesis, commonly known as fusion, is a surgical procedure aimed at alleviating severe elbow pain, particularly in cases where conservative treatments, such as medication or physical therapy, have failed to provide relief. This procedure is often indicated for patients suffering from debilitating arthritis or those who have experienced significant trauma to the elbow joint. The surgery involves creating a permanent connection between the bones of the elbow joint, effectively eliminating movement in the joint to reduce pain. The procedure begins with a skin incision made over the posterior aspect of the elbow, allowing access to the joint. Surgeons then retract the tendons and ligaments to expose the joint surfaces. The articular cartilage from the radial head, olecranon process of the ulna, and the distal articular surface of the humerus is meticulously removed using a bur. The elbow is positioned at a 90-degree angle to ensure proper alignment of the radius, ulna, and humerus. Bone grafts, which are essential for the fusion process, can be harvested either through the same incision or from a separate site, depending on the surgical approach. Once the graft is prepared, it is packed into the joint space to facilitate the fusion of the bones. To stabilize the joint during the healing process, the bones may be immobilized using plate and screw fixation or an external fixation device. After the procedure, the incisions are closed, and if plate and screw fixation is utilized, the arm is typically placed in a cast or splint to ensure proper healing and alignment.
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The procedure of arthrodesis of the elbow joint is indicated for specific conditions that lead to severe pain and dysfunction. The following are the primary indications for performing this surgical intervention:
The arthrodesis procedure involves several critical steps to ensure successful fusion of the elbow joint. The following outlines the procedural steps:
After the arthrodesis procedure, patients can expect specific post-operative care and recovery considerations. The arm will typically be immobilized in a cast or splint if plate and screw fixation has been used, which helps to maintain the proper alignment of the bones during the healing process. Patients are usually monitored for any signs of complications, such as infection or non-union of the graft. Rehabilitation may be initiated after a period of immobilization, focusing on restoring function and strength to the elbow joint. The overall recovery time can vary based on individual healing rates and adherence to post-operative care instructions.
| Short Descr | FUSION/GRAFT OF ELBOW JOINT | Medium Descr | ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT | Long Descr | Arthrodesis, elbow joint; with autogenous graft (includes obtaining graft) | 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) | 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 | Non office-based surgical procedure added in CY 2008 or later; 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 | 162 - Other OR therapeutic procedures on joints |
This is a primary code that can be used with these additional add-on codes.
| 20705 | Add-on Code MPFS Status: Active Code APC N Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary 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). | 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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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