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An amputation through the wrist joint, referred to as disarticulation through the wrist, is a surgical procedure that involves the complete removal of the hand and wrist at the wrist joint. This procedure is performed when it is necessary to remove the hand due to severe injury, disease, or other medical conditions that compromise the viability of the hand. During the procedure, both palmar and dorsal flaps are created, which are sections of skin and soft tissue that are preserved to cover the area after the amputation. The surgical team carefully divides the finger flexor and extensor tendons, allowing them to retract, and identifies the wrist flexor and extensor tendons, which are then released from their distal insertions. The median and ulnar nerves, which are critical for hand function, are identified and sectioned above the amputation site to prevent nerve damage. Additionally, the radial and ulnar arteries are ligated to control bleeding. The actual disarticulation occurs just below the radius and ulna, with attention given to preserving the triangular fibrocartilage, an important structure for wrist stability. After the hand and wrist are severed, the remaining bone ends are rounded off, and the skin and soft tissue flaps are meticulously configured to cover the exposed areas, ensuring a proper healing environment. This procedure is essential for patients who require amputation to improve their quality of life, particularly when a prosthesis is to be fitted post-operatively.
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The procedure of disarticulation through the wrist is indicated for several specific conditions and circumstances, including:
The disarticulation through the wrist involves several critical procedural steps, which are detailed as follows:
After the disarticulation through the wrist, post-procedure care is critical for optimal recovery. Patients are typically monitored for any signs of infection or complications at the surgical site. Pain management is an essential component of post-operative care, and patients may be prescribed analgesics to manage discomfort. The surgical site will require regular dressing changes to maintain cleanliness and promote healing. Rehabilitation may be initiated to help the patient adapt to the loss of the hand and to prepare for the fitting of a prosthesis. The goal of post-procedure care is to ensure a pain-free stump that is well-suited for prosthetic use, allowing the patient to regain functionality and improve their quality of life.
| Short Descr | AMPUTATE HAND AT WRIST | Medium Descr | DISARTICULATION THROUGH WRIST | Long Descr | Disarticulation through 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) | 0 - Payment restriction for assistants at surgery applies 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 |
| 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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. | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | 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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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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