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Fusion in opposition of the thumb at the carpometacarpal (CMC) joint is a surgical procedure primarily aimed at addressing conditions such as arthritis or instability affecting the joint. The CMC joint is crucial for thumb movement, particularly for opposition, which is the action of bringing the thumb across the palm towards the small finger. This procedure involves several technical steps, including making an incision on the lateral side of the thumb to access the CMC joint. The surgeon inspects the joint surfaces by incising the joint capsule and excising any damaged articular cartilage from both the metacarpal base and the trapezium bone. To ensure proper fit and function, the trapezium is reshaped using a bur. A bone autograft, typically harvested from the iliac crest, is then prepared to fill the defect created during the procedure. The graft is secured in place using internal fixation methods, such as pins or wires, to maintain the thumb's position in opposition while the joint heals and fuses. Finally, the soft tissues are meticulously repaired, and a short arm cast is applied to support the recovery process.
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The procedure of thumb fusion in opposition is indicated for specific conditions that compromise the function and stability of the CMC joint. These indications include:
The surgical procedure for thumb fusion in opposition involves several critical steps to ensure successful outcomes. The steps are as follows:
After the procedure, patients can expect a recovery period during which the thumb will be immobilized in a short arm cast. This immobilization is crucial for allowing the joint to heal and the graft to integrate properly. Patients may experience some swelling and discomfort, which can be managed with prescribed pain relief. Follow-up appointments will be necessary to monitor the healing process and assess the success of the fusion. Rehabilitation exercises may be introduced gradually to restore function and strength to the thumb once adequate healing has occurred.
| Short Descr | THUMB FUSION WITH GRAFT | Medium Descr | FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT | Long Descr | Fusion in opposition, thumb, with autogenous graft (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 | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 162 - Other OR therapeutic procedures on joints |
| 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F1 | Left hand, second digit | F5 | Right hand, thumb | FA | Left hand, thumb | 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) | SG | Ambulatory surgical center (asc) facility service |
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| Pre-1990 | Added | Code added. |
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