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The procedure described by CPT® Code 25430 involves the insertion of a vascular pedicle into a carpal bone, commonly referred to as the Hori procedure. This surgical intervention is specifically designed to restore blood supply to a carpal bone that has experienced ischemia, which can lead to osteonecrosis if not addressed. The carpal bones, particularly the lunate, are susceptible to a loss of blood supply for various reasons, resulting in potential complications such as pain, dysfunction, and structural failure of the bone. During the procedure, a surgical incision is made on the posterior aspect of the wrist, directly over the affected carpal bone. The surrounding tendons are carefully retracted to provide access to the underlying structures. The surgeon then isolates the terminal branches of the interosseous artery and vein, ligating and transecting them distal to the carpal bone to facilitate the mobilization of the vascular pedicle. A drill hole is created in the carpal bone to allow for the insertion of the interosseous artery and vein, which are then secured within the bone and attached to the periosteum to ensure proper blood flow. Finally, the joint capsule is repaired, and the soft tissues and skin are closed in layers, completing the procedure and aiming to restore normal function and blood supply to the affected carpal bone.
© Copyright 2025 Coding Ahead. All rights reserved.
The insertion of a vascular pedicle into a carpal bone, as described by CPT® Code 25430, is indicated for specific conditions related to compromised blood supply to the carpal bones. The following are the primary indications for this procedure:
The procedure for the insertion of a vascular pedicle into a carpal bone involves several critical steps, each designed to ensure the successful restoration of blood supply. The following outlines the procedural steps:
After the procedure, patients can expect a recovery period that may involve immobilization of the wrist to promote healing. Post-operative care typically includes monitoring for signs of infection, managing pain, and ensuring proper blood flow to the area. Rehabilitation may be necessary to restore function and strength to the wrist, and follow-up appointments will be scheduled to assess the healing process and the success of the vascular pedicle insertion. Patients should be advised on activity restrictions during the recovery phase to prevent complications and ensure optimal outcomes.
| Short Descr | VASC GRAFT INTO CARPAL BONE | Medium Descr | INSERTION VASCULAR PEDICLE CARPAL BONE | Long Descr | Insertion of vascular pedicle into carpal bone (eg, Hori procedure) | 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 | 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) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 161 - Other OR therapeutic procedures on bone |
| 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. | 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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| 2003-01-01 | Changed | Code description changed. |
| 2002-01-01 | Added | First appearance in code book in 2002. |
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