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Diagnostic arthroscopy of the wrist is a minimally invasive surgical procedure that allows for direct visualization of the wrist joint's internal structures. This procedure can be performed with or without the collection of synovial tissue biopsies. During the procedure, a pneumatic tourniquet is applied to the upper arm to minimize blood flow, which aids in clearer visualization of the joint. The forearm is then positioned in a wrist traction device, and weights are applied to the second and third fingers, creating distraction within the wrist joint. This distraction enhances the surgeon's ability to see the joint structures more clearly. A small incision, referred to as a portal, is made on the posterior aspect of the wrist, through which an arthroscope—a specialized instrument equipped with a camera—is introduced. The camera magnifies the internal view of the wrist and projects it onto a video screen for the surgeon to observe. To further facilitate the examination, another portal incision is made to insert an irrigation cannula, allowing fluid to be introduced into the joint space, which helps to expand it for better visibility. Additional small incisions may be created as necessary to provide different angles of view. The wrist is thoroughly examined for any signs of injury or disease, and if required, biopsies of the synovial tissue are taken for laboratory analysis. Upon completion of the procedure, the wrist is flushed with saline solution, the instruments are carefully removed, and the portal incisions are closed to promote healing.
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The diagnostic arthroscopy of the wrist is indicated for various conditions that may affect the wrist joint. These indications include:
The procedure for diagnostic arthroscopy of the wrist involves several key steps:
Following the diagnostic arthroscopy of the wrist, patients are typically monitored for any immediate complications. Post-procedure care may include recommendations for rest, elevation of the wrist, and the application of ice to reduce swelling. Patients may also be advised on pain management strategies, which could include over-the-counter analgesics. The wrist may be immobilized in a splint or brace for a specified period to facilitate healing. Follow-up appointments are usually scheduled to assess recovery and discuss any findings from the procedure, including biopsy results if applicable. It is important for patients to adhere to the post-operative instructions provided by their healthcare provider to ensure optimal recovery.
| Short Descr | WRIST ARTHROSCOPY | Medium Descr | ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX | Long Descr | Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure) | 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 | 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) | P8A - Endoscopy - arthroscopy | MUE | 1 | CCS Clinical Classification | 149 - Arthroscopy |
| 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). | 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. | 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). | 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 | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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