Coding Ahead
CasePilot
Medical Coding Assistant
Case2Code
Search and Code Lookup Tool
RedactPHI
HIPAA-Compliant PHI Redaction
DetectICD10CM
ICD-10-CM Code Detection
Log in Register free account
1 code page views remaining. Guest accounts are limited to 1 page view. Register free account to get 5 more views.
Log in Register free account

Official Description

Arthroplasty with prosthetic replacement; lunate

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Arthroplasty with prosthetic replacement of the lunate involves the surgical procedure where the damaged lunate bone in the wrist is replaced with a prosthetic implant. This procedure is typically indicated for patients suffering from severe wrist pain or dysfunction due to conditions such as avascular necrosis, trauma, or degenerative diseases affecting the lunate bone. The surgery aims to restore normal wrist function and alleviate pain by removing the damaged bone and replacing it with an artificial component. The procedure requires careful dissection and exposure of the wrist joint, ensuring that surrounding structures, including nerves and tendons, are protected throughout the operation. The use of a prosthetic component allows for improved mobility and function of the wrist post-surgery, making it a critical intervention for patients with significant wrist impairment.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

Arthroplasty with prosthetic replacement of the lunate is performed for specific indications, which include:

  • Avascular Necrosis - A condition where the blood supply to the lunate bone is compromised, leading to bone death and subsequent pain and dysfunction.
  • Trauma - Injuries to the lunate bone that result in fractures or severe damage, necessitating surgical intervention for repair or replacement.
  • Degenerative Diseases - Conditions such as osteoarthritis that cause deterioration of the lunate bone, leading to chronic pain and limited range of motion in the wrist.

2. Procedure

The procedure for arthroplasty with prosthetic replacement of the lunate involves several critical steps:

  • Step 1: Incision - A midline incision is made 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.
  • Step 2: Exposure of the Joint - The retinaculum, a fibrous band that holds the tendons in place, is released starting from the ulnar border and extending to the radial border. This step is crucial for accessing the underlying structures of the wrist.
  • Step 3: Nerve Protection - The radial and ulnar nerves are carefully protected using vessel loops to prevent any injury during the procedure.
  • Step 4: Joint Capsule Elevation - The dorsal aspect of the joint capsule is elevated as a single layer to facilitate access to the lunate bone.
  • Step 5: Resection of the Damaged Bone - The damaged lunate bone is resected using an oscillating saw, which allows for precise removal of the affected bone.
  • Step 6: Trial Component Placement - A trial carpal component is secured to the site of the resected lunate bone to evaluate fit and function. Adjustments are made as necessary to ensure proper alignment and stability.
  • Step 7: Final Prosthetic Component Insertion - Once the trial component is deemed satisfactory, the final prosthetic components are tamped into place, ensuring a secure fit within the wrist joint.
  • Step 8: Stabilization - Sutures are placed through the triangular fibrocartilage to stabilize the prosthetic component, providing additional support to the wrist.
  • Step 9: Closure of the Joint Capsule - The dorsal aspect of the joint capsule is returned to its normal position and repaired with sutures to restore the integrity of the wrist joint.
  • Step 10: Repair of Soft Tissues - The retinaculum and overlying soft tissues, including the skin, are repaired in layers to ensure proper healing and minimize scarring.

3. Post-Procedure

After the arthroplasty with prosthetic replacement of the lunate, patients can expect a recovery period that may involve immobilization of the wrist in a splint or cast to allow for healing. Pain management and rehabilitation exercises are typically initiated to restore mobility and strength in the wrist. Follow-up appointments are essential to monitor the healing process and ensure the proper function of the prosthetic component. Patients should be advised on activity modifications during the recovery phase to prevent complications and promote optimal outcomes.

Short Descr ARTHRP W/PROSTC LUNATE
Medium Descr ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE
Long Descr Arthroplasty with prosthetic replacement; lunate
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 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.
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.)
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)
SG Ambulatory surgical center (asc) facility service
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
Date
Action
Notes
2025-01-01 Changed Short Description changed.
Pre-1990 Added Code added.
Code
Description
Code
Description
Code
Description
Code
Description
CasePilot

Get instant expert-level medical coding assistance.

Ask about:
CPT Codes Guidelines Modifiers Crosswalks NCCI Edits Compliance Medicare Coverage
Example: "What is CPT code 99213?" or "Guidelines for E/M services"