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Surgical arthroscopy of the wrist is a minimally invasive procedure that involves the examination and treatment of the wrist joint through small incisions. The specific procedure described by CPT® Code 29845 refers to a complete synovectomy, which is the surgical removal of the synovial tissue that lines the joint. This procedure is typically indicated for patients suffering from conditions that cause inflammation of the synovial tissue, such as rheumatoid arthritis. During the procedure, the patient is positioned supine, and a pneumatic tourniquet is applied to the upper arm to minimize blood flow to the area, enhancing visibility and control during surgery. The use of a wrist traction device allows for distraction of the wrist joint, facilitating a clearer view of the internal structures. The arthroscope, a specialized camera, is inserted through a small incision, enabling the surgeon to visualize the joint and identify inflamed tissue. The complete removal of this tissue is essential for alleviating symptoms and improving joint function. This procedure is distinct from a partial synovectomy, which is performed when only a portion of the synovial tissue is removed, and is coded differently (CPT® Code 29844).
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The procedure described by CPT® Code 29845 is indicated for the following conditions:
The procedure for a complete synovectomy of the wrist involves several key steps:
After the completion of the synovectomy, the patient may require monitoring for any immediate complications. Post-procedure care typically includes pain management and instructions for activity restrictions to promote healing. Patients are often advised to keep the wrist elevated and may be prescribed physical therapy to restore function and mobility. Follow-up appointments are essential to assess recovery and ensure that the joint is healing properly.
| Short Descr | WRIST ARTHROSCOPY/SURGERY | Medium Descr | ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE | Long Descr | Arthroscopy, wrist, surgical; synovectomy, complete | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic 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. | Endoscopic Base Code | 29840 Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate 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 | 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). | 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.) | 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 | F5 | Right hand, thumb | FA | Left hand, thumb | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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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| Pre-1990 | Added | Code added. |
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