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The procedure described by CPT® Code 25446 refers to an arthroplasty involving the prosthetic replacement of the distal radius and either partial or complete replacement of the carpal bones, commonly known as a total wrist replacement. This surgical intervention is indicated for patients suffering from severe wrist joint conditions, such as advanced arthritis, trauma, or degenerative diseases that compromise the function and integrity of the wrist. The surgery aims to alleviate pain, restore mobility, and improve the overall quality of life for individuals with debilitating wrist conditions. During the procedure, a midline incision is made on the posterior aspect of the wrist, allowing access to the radiocarpal joint and the distal radioulnar joint (DRUJ). The surgical team meticulously releases the retinaculum and protects the surrounding nerves while resecting the necessary carpal bones and distal radius to accommodate the prosthetic components. The careful placement and stabilization of the prosthesis are crucial for achieving optimal functional outcomes post-surgery.
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The procedure is indicated for the following conditions:
The procedure involves several critical steps to ensure successful arthroplasty with prosthetic replacement:
Post-procedure care involves monitoring the surgical site for signs of infection and ensuring proper healing. Patients are typically advised on rehabilitation exercises to restore mobility and strength in the wrist. Follow-up appointments are essential to assess the integration of the prosthetic components and to make any necessary adjustments to the rehabilitation plan. Pain management strategies may also be implemented to enhance recovery.
| Short Descr | ARTHRP W/PROSTC DST RDS&CRPS | Medium Descr | ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/ENTIR CARPS | Long Descr | Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (total wrist) | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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 | F9 | Right hand, fifth digit | 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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| 2025-01-01 | Changed | Short and Medium Descriptions changed. |
| Pre-1990 | Added | Code added. |
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