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The CPT® Code 25905 refers to an open, circular (guillotine) amputation of the forearm, specifically through the radius and ulna. This procedure is categorized as a below-elbow amputation, which can be performed at various levels: high, middle, or low, depending on the specific clinical situation and the extent of the amputation required. In a high amputation, the procedure is performed a few centimeters below the elbow joint, while a middle amputation occurs through the shafts of the radius and ulna, and a low amputation is executed a few centimeters above the wrist. The surgical approach involves positioning the patient with the operative side's shoulder slightly elevated to facilitate access to the forearm. During the procedure, the surgeon marks the incision lines on the skin, typically utilizing an anterior/posterior fish-mouth flap technique. The incision is made perpendicular to the skin surface, allowing for the dissection of underlying soft tissue, where blood vessels and nerves are identified and managed. The large blood vessels are mobilized, ligated, and divided, while nerves are carefully handled to prevent damage. The radius and ulna are exposed, and periosteal flaps are created to ensure proper closure after the bones are transected. The procedure emphasizes maintaining equal lengths of the bones and ensuring that the remaining bone structures are adequately enveloped in muscle tissue to promote healing and function post-surgery. The circular amputation technique, as described in this code, involves making skin incisions in a circular manner at the predetermined site, followed by the careful dissection and management of soft tissue, ultimately leading to the closure of the surgical site with a rigid dressing to minimize pain and swelling.
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The procedure described by CPT® Code 25905 is indicated for patients requiring an amputation of the forearm through the radius and ulna due to various conditions. These may include:
The procedure for CPT® Code 25905 involves several critical steps to ensure a successful amputation. The following outlines the procedural steps:
Post-procedure care following a circular amputation involves monitoring the surgical site for signs of infection and ensuring proper healing. The patient may require pain management strategies to address discomfort associated with the amputation. Rehabilitation services may be initiated to assist the patient in adapting to the loss of the forearm and to promote functional recovery. Follow-up appointments are essential to assess the healing process and to make any necessary adjustments to the treatment plan.
| Short Descr | AMPUTATION OF FOREARM | Medium Descr | AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR | Long Descr | Amputation, forearm, through radius and ulna; open, circular (guillotine) | 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 | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 164 - Other OR therapeutic procedures on musculoskeletal system |
| 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.) | 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 | GW | Service not related to the hospice patient's terminal condition | 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 |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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