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An amputation through the wrist joint, referred to as disarticulation, involves the surgical removal of the hand and wrist at the level of the wrist joint. This procedure is performed when there is a need to remove the hand due to various medical conditions, such as severe trauma, infection, or other pathological conditions that compromise the integrity of the hand and wrist. The surgical technique includes the creation of palmar and dorsal flaps, which are formed from the skin and soft tissue surrounding the wrist, allowing for effective closure of the surgical site. During the procedure, the finger flexor and extensor tendons are carefully divided and allowed to retract, while the wrist flexor and extensor tendons are identified, released, and reflected away from the operative area. The median and ulnar nerves, which are critical for hand function, are also identified and sectioned above the amputation site to prevent any nerve damage during the procedure. Additionally, the radial and ulnar arteries are ligated to control bleeding. The disarticulation is performed just below the radius and ulna, ensuring that the triangular fibrocartilage is preserved to maintain the integrity of the wrist joint. After the amputation, the skin and soft tissue flaps are meticulously configured to cover the distal ends of the radius and ulna. In cases where a secondary closure or scar revision is necessary, the procedure aims to create a pain-free stump that is well-suited for prosthetic use. This involves debriding the raw surface of the stump, excising any devitalized tissue, and fashioning skin flaps to cover the area, ensuring optimal healing and functionality.
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The procedure of disarticulation through the wrist, specifically CPT® Code 25922, is indicated for the following conditions:
The procedure for disarticulation through the wrist involves several critical steps to ensure a successful outcome. First, the surgeon creates palmar and dorsal flaps, which are skin and soft tissue flaps that are formed beginning distal to the radial and ulnar styloid processes. This is essential for providing adequate coverage of the surgical site post-amputation. Next, the finger flexor and extensor tendons are carefully divided and allowed to retract, which facilitates access to the deeper structures of the wrist. The wrist flexor and extensor tendons are then identified, released from their distal insertions, and reflected away from the operative site to prevent any interference during the disarticulation. Following this, the median and ulnar nerves are identified and sectioned proximal to the amputation site to prevent nerve damage. Additionally, each of the distal branches of the radial nerve is also sectioned in a similar manner. The radial and ulnar arteries are ligated at the appropriate level to control bleeding during the procedure. The hand and wrist are then severed just below the radius and ulna, with careful attention to preserving the triangular fibrocartilage, which is crucial for maintaining wrist stability. The radial and ulnar styloids are rounded off as necessary to ensure a smooth stump. Finally, the skin and soft tissue flaps are configured to cover the distal aspect of the radius and ulna, providing a suitable surface for healing.
In cases where a secondary closure or scar revision is performed, the raw surface of the stump is debrided, and all devitalized tissue is excised to promote healing. Skin and subcutaneous tissue are fashioned into flaps that are used to cover the stump effectively. For scar revision, the existing scar tissue is excised, and skin flaps are fashioned with the edges undermined to ensure a smooth, tension-free approximation along the suture line, which is critical for optimal healing and function.
Post-procedure care following a wrist disarticulation involves monitoring the surgical site for signs of infection and ensuring proper healing of the stump. Patients are typically advised on wound care practices to maintain cleanliness and prevent complications. Pain management is also an essential aspect of post-operative care, as patients may experience discomfort during the recovery phase. Rehabilitation may be necessary to help the patient adapt to the loss of the hand and to prepare for the use of a prosthesis. This may include physical therapy to strengthen the remaining limb and improve functionality. The goal of post-procedure care is to ensure a pain-free stump that is well-suited for prosthetic fitting and to support the patient's overall recovery and adjustment to their new circumstances.
| Short Descr | AMPUTATE HAND AT WRIST | Medium Descr | DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ | Long Descr | Disarticulation through wrist; secondary closure or scar revision | 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 | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | 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. |
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| Pre-1990 | Added | Code added. |
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