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The CPT® Code 24900 refers to the surgical procedure of amputation of the arm through the humerus, specifically with primary closure. This procedure is categorized as an above-elbow amputation, which can be performed at various levels: high, middle, or low. A high amputation occurs at the proximal metaphysis above the deltoid tuberosity, a middle amputation is performed along the diaphysis, and a low amputation is done at the supracondylar level. During the procedure, the patient is positioned with the shoulder slightly elevated on the operative side to facilitate access to the arm. The surgical team marks the incision lines for the skin and muscle flaps on the skin surface, typically utilizing an anterior/posterior fishmouth flap technique. This method involves making incisions that are perpendicular to the skin surface, allowing for the careful dissection of underlying soft tissue, where blood vessels and nerves are identified and managed. The procedure requires meticulous attention to detail to ensure that large blood vessels are mobilized, ligated, and divided, while nerves are also carefully handled to prevent complications. The muscles are transected along the marked flap lines, and the humerus is exposed for transection at the level of the periosteal flaps. The remaining bone is then covered with sutured muscle flaps, ensuring that the humerus is completely enveloped in muscle tissue, which may be reinforced with synthetic tape to stabilize the muscle. Post-operative care includes the placement of drains, closure of the subcutaneous fascia and skin, and the application of a rigid dressing to manage pain and prevent edema.
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The procedure described by CPT® Code 24900 is indicated for patients requiring an above-elbow amputation due to various conditions. These may include severe trauma to the arm, malignancies affecting the humerus, or chronic infections that cannot be managed through other means. The decision to perform this procedure is typically based on the need to remove the affected limb segment to alleviate pain, prevent further complications, or improve the patient's quality of life.
The procedure for CPT® Code 24900 involves several critical steps to ensure a successful amputation. Initially, the surgical team positions the patient with the shoulder slightly elevated on the operative side to provide optimal access to the arm. The first step involves marking the incision lines for the skin and muscle flaps on the skin surface, typically using an anterior/posterior fishmouth flap technique. This technique allows for a more controlled incision and better healing outcomes. Following this, the skin and superficial fascia are incised perpendicular to the skin surface, which facilitates access to the underlying soft tissue. The surgeon then carefully dissects the soft tissue to expose the blood vessels and nerves, which are crucial to manage during the procedure. Large blood vessels are mobilized, suture ligated, and divided to prevent excessive bleeding. Nerves are also mobilized from the muscular bed, doubly ligated, and divided, allowing them to retract into the muscle tissue to minimize nerve damage. Next, the muscles are transected along the previously marked flap lines, exposing the humerus. Periosteal flaps are created to prepare for the transection of the bone. The humerus is then transected at the level of the periosteal flaps, ensuring a clean cut. After the bone is cut, the flaps are sutured over the remaining bone to promote healing. The antagonistic muscle groups are sutured to each other and anchored to the periosteum, ensuring that the remaining portion of the humerus is completely enveloped in muscle. To further stabilize the muscle tissue, muscle sutures may be reinforced using synthetic tape that is placed through drill holes in the humerus. This step is crucial to prevent movement of the muscle tissue during the healing process. Finally, drains are placed to manage any excess fluid, and the subcutaneous fascia and skin are closed around the drains. A rigid dressing is then applied to the site to reduce pain and prevent edema, completing the procedure.
After the completion of the amputation procedure, the patient will require careful monitoring and post-operative care. The application of a rigid dressing is essential to minimize pain and control swelling at the surgical site. Patients are typically advised to keep the dressing intact and dry to promote healing. Pain management strategies will be implemented, which may include medications as prescribed by the healthcare provider. The surgical team will monitor the site for any signs of infection or complications, such as excessive bleeding or poor healing. Follow-up appointments will be necessary to assess the healing process and to discuss rehabilitation options, including the potential for prosthetic fitting if appropriate. The overall recovery will depend on the individual patient's health status and adherence to post-operative care instructions.
| Short Descr | AMPUTATION OF UPPER ARM | Medium Descr | AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE | Long Descr | Amputation, arm through humerus; with primary closure | 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) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 164 - Other OR therapeutic procedures on musculoskeletal system |
| 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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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