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Arthrodesis, commonly known as joint fusion, is a surgical procedure aimed at alleviating pain and restoring stability to the wrist joint. This procedure is particularly beneficial for patients suffering from various conditions such as rheumatoid arthritis, osteoarthritis, post-traumatic arthritis, spastic flexion contracture, degenerative scaphoid nonunion, or those who have experienced failure of wrist arthroplasty. The surgery involves making an incision along the midline of the posterior wrist, extending from the distal forearm to the proximal metacarpal area. During the procedure, the surgeon exposes the radiocarpal joint and the distal radioulnar joint (DRUJ) by carefully releasing the retinaculum, which is a fibrous band that holds the tendons in place. This release is performed from the ulnar side to the radial side, ensuring that the surrounding nerves, specifically the radial and ulnar nerves, are protected using vessel loops. The surgical team retracts the tendons to gain access to the joint surfaces, where articular cartilage is meticulously removed using specialized instruments such as a rongeur or bur. Following this preparation, the procedure may involve the use of internal fixation devices to immobilize the joint, and in the case of CPT® Code 25825, a bone graft is harvested, typically from a local source. The graft, which may consist of cortical bone chips or morcellized cancellous bone, is then placed into the joint space and secured with pins or wires. Finally, the surgical site is closed in layers, and the wrist is immobilized in a cast to promote healing and stability post-surgery.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure of arthrodesis of the wrist is indicated for patients experiencing significant pain and instability in the wrist joint due to various underlying conditions. These indications include:
The arthrodesis procedure involves several critical steps to ensure successful fusion of the wrist joint. The process begins with the surgeon making a midline incision over the posterior aspect of the wrist, extending from the distal forearm to the proximal metacarpal. This incision allows access to the radiocarpal joint and the distal radioulnar joint (DRUJ). Once the incision is made, the retinaculum, a fibrous band that stabilizes the tendons, is released starting from the ulnar border and extending to the radial border. This careful release is essential to expose the joint adequately while protecting the surrounding structures.
During the procedure, the surgeon takes precautions to protect the radial and ulnar nerves by using vessel loops. The tendons are retracted to provide a clear view of the joint surfaces. The next step involves the removal of articular cartilage from the joint surfaces using a rongeur or bur, which prepares the bones for fusion. In cases where limited fusion is required, internal fixation devices such as pins or plates and screws may be utilized to stabilize the radiocarpal or intercarpal joints.
For the specific procedure coded as CPT® 25825, a bone graft is harvested, typically from a local site. The graft may consist of cortical bone chips or morcellized cancellous bone, which is then placed into the joint space to facilitate fusion. The graft is secured in place using pins or wires to ensure stability during the healing process. After the grafting is completed, the surgical wound is meticulously closed in layers to promote optimal healing, and the wrist is immobilized in a cast to support recovery and maintain the position of the fused joint.
Post-procedure care following wrist arthrodesis is crucial for successful recovery. Patients are typically advised to keep the wrist immobilized in a cast for a specified duration to allow for proper healing of the bone graft and fusion. Pain management strategies may be implemented to address discomfort during the recovery period. Regular follow-up appointments are essential to monitor the healing process and assess the success of the fusion. Rehabilitation may be recommended after the initial healing phase to restore function and strength to the wrist, although the timeline for rehabilitation will depend on the individual patient's healing progress and the specific surgical approach taken.
| Short Descr | ARTHRD WRIST WITH AUTOGRAFT | Medium Descr | ARTHRODESIS WRIST WITH AUTOGRAFT | Long Descr | Arthrodesis, wrist; with autograft (includes obtaining graft) | 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 | 162 - Other OR therapeutic procedures on joints |
This is a primary code that can be used with these additional add-on codes.
| 20705 | Add-on Code MPFS Status: Active Code APC N Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure) |
| RT | Right side (used to identify procedures performed on the right side of the body) | LT | Left side (used to identify procedures performed on the left side of the body) | SG | Ambulatory surgical center (asc) facility service | 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. | 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. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 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). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2025-01-01 | Changed | Short and Medium Descriptions changed. |
| Pre-1990 | Added | Code added. |
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