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Official Description

Arthroplasty with prosthetic replacement; distal ulna

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 25442 refers to an arthroplasty involving the prosthetic replacement of the distal ulna, which is a surgical intervention aimed at addressing conditions affecting the distal ulna, often due to trauma, arthritis, or other degenerative diseases. The distal ulna is the end portion of the ulna bone located near the wrist, and its replacement is typically indicated when the bone is severely damaged or diseased. The surgery involves making an incision along the posterior aspect of the wrist, allowing access to the radiocarpal joint and the distal radioulnar joint (DRUJ). During the procedure, careful attention is given to protect the surrounding nerves and tendons, ensuring that the surgical field is clear for the replacement of the distal ulna with a prosthetic component. This intervention aims to restore function and alleviate pain in the wrist, ultimately improving the patient's quality of life. The procedure is performed under sterile conditions, and the surgical team follows strict protocols to ensure the best possible outcomes for the patient.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 25442 is indicated for patients experiencing significant dysfunction or pain in the wrist due to conditions affecting the distal ulna. The following are specific indications for performing this arthroplasty:

  • Severe Arthritis - Patients with advanced arthritis affecting the distal ulna may require this procedure to alleviate pain and restore function.
  • Traumatic Injury - Fractures or other traumatic injuries to the distal ulna that do not heal properly may necessitate prosthetic replacement.
  • Degenerative Joint Disease - Conditions leading to the degeneration of the distal ulna can result in pain and limited mobility, making this procedure necessary.
  • Instability of the Distal Radioulnar Joint - Instability or dysfunction in the distal radioulnar joint may require surgical intervention to restore stability and function.

2. Procedure

The surgical procedure for CPT® Code 25442 involves several critical steps to ensure the successful replacement of the distal ulna. The following outlines the procedural steps:

  • Step 1: Incision and Exposure - An incision is made in the midline over the posterior aspect of the wrist, extending from the distal forearm to the proximal metacarpal. This incision allows for adequate exposure of the radiocarpal joint and the distal radioulnar joint (DRUJ).
  • Step 2: Retinaculum Release - The retinaculum is released, starting from the ulnar border and extending to the radial border, facilitating access to the underlying structures.
  • Step 3: Nerve Protection - The radial and ulnar nerves are carefully protected using vessel loops to prevent any injury during the procedure.
  • Step 4: Tendon Retraction - The tendons in the area are retracted to provide a clear view of the joint capsule and surrounding structures.
  • Step 5: Joint Capsule Elevation - The dorsal aspect of the joint capsule is elevated as a single layer, allowing for further access to the distal ulna.
  • Step 6: Distal Ulna Excision - The distal ulna is excised, preparing the site for the prosthetic replacement.
  • Step 7: Prosthesis Selection and Testing - An appropriately sized prosthesis is selected and tested for fit. Adjustments are made as necessary to ensure proper alignment and function.
  • Step 8: Final Prosthesis Securing - The final ulnar prosthesis is secured in place, ensuring stability and proper function.
  • Step 9: Closure of Joint Capsule and Soft Tissues - The joint capsule, retinaculum, soft tissues, and skin are closed in layers, restoring the integrity of the wrist.

3. Post-Procedure

After the completion of the arthroplasty procedure, patients typically undergo a recovery period that may involve monitoring for complications, managing pain, and beginning rehabilitation. Post-procedure care includes immobilization of the wrist to allow for healing, followed by a structured physical therapy program to restore range of motion and strength. Patients are advised on activity restrictions and follow-up appointments to assess the healing process and the function of the prosthetic replacement. It is essential to monitor for any signs of infection or complications during the recovery phase to ensure optimal outcomes.

Short Descr ARTHRP W/PROSTC DSTL ULNA
Medium Descr ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA
Long Descr Arthroplasty with prosthetic replacement; distal ulna
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 Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P3D - Major procedure, orthopedic - other
MUE 1
CCS Clinical Classification 154 - Arthroplasty other than hip or knee
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.
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.
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.)
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
F5 Right hand, thumb
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)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
Date
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2025-01-01 Changed Short Description changed.
Pre-1990 Added Code added.
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