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Surgical arthroscopy of the wrist, as described by CPT® Code 29847, involves a minimally invasive procedure aimed at addressing fractures or instability within the wrist joint. This technique utilizes an arthroscope, a specialized instrument equipped with a camera, to visualize the internal structures of the wrist. The procedure begins with the patient positioned supine, which means lying on their back, with the shoulder abducted to facilitate access to the wrist. A pneumatic tourniquet is applied to the upper arm to minimize blood flow to the area, enhancing visibility during the surgery. The forearm is then suspended in a wrist traction device, and weights are applied to the second and third fingers, creating distraction in the wrist joint. This distraction is crucial as it allows for improved visualization of the joint's anatomy and any potential injuries. The surgical approach involves making a portal incision on the posterior aspect of the wrist, through which the arthroscope is introduced. Additional portal incisions may be created as necessary to allow for the insertion of other instruments, such as cannulas, which facilitate the manipulation of tissues and fixation devices. During the procedure, the wrist is thoroughly examined, and if a fracture is identified, the surgeon will remove any fracture fragments and align the bones at the fracture site. To stabilize the fracture, various fixation devices such as pins, wires, or screws are utilized. Once the surgical intervention is complete, the joint is flushed with normal saline to clear any debris, and the arthroscope along with other surgical instruments are removed. Finally, the portal incisions are closed, concluding the procedure.
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The procedure described by CPT® Code 29847 is indicated for specific conditions related to the wrist. These include:
The surgical procedure for CPT® Code 29847 involves several critical steps to ensure effective treatment of wrist fractures or instability. The first step is positioning the patient in a supine position, which allows optimal access to the wrist. The shoulder is abducted to facilitate the procedure. Following this, a pneumatic tourniquet is applied to the upper arm to control blood flow, which is essential for maintaining a clear surgical field. The forearm is then suspended in a wrist traction device, and weights of 7-10 lbs are applied to the second and third fingers. This traction helps to distract the wrist joint, enhancing visualization of the internal structures during the arthroscopy. Next, a portal incision is made over the posterior aspect of the wrist, and the arthroscope is introduced through this incision. The arthroscope provides a visual feed of the joint interior, allowing the surgeon to assess the condition of the wrist. If additional access is required, another portal incision is made, and a cannula is introduced to facilitate the insertion of surgical instruments. As the wrist is examined, if a fracture is detected, the surgeon will proceed to remove any fracture fragments that may obstruct proper healing. The bones at the fracture site are then aligned to restore normal anatomy. To stabilize the fracture, the surgeon may insert pins, wires, or screws, depending on the specific nature of the fracture and the required stabilization method. Once the necessary repairs are completed, the joint is flushed with normal saline to clear any debris and ensure a clean environment. Finally, the arthroscope and any surgical instruments are removed, and the portal incisions are closed to complete the procedure.
After the completion of the arthroscopic procedure, the patient will typically undergo a recovery period that may involve monitoring for any immediate complications. Post-procedure care may include pain management, which can involve prescribed medications to alleviate discomfort. The patient may also be advised on immobilization of the wrist to promote healing and prevent further injury. Rehabilitation exercises may be recommended to restore range of motion and strength in the wrist as healing progresses. Follow-up appointments will be necessary to assess the healing process and determine when the patient can safely resume normal activities.
| Short Descr | WRIST ARTHROSCOPY/SURGERY | Medium Descr | ARTHROSCOPY WRIST SURG INT FIXJ FX/INSTABILITY | Long Descr | Arthroscopy, wrist, surgical; internal fixation for fracture or instability | 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) | 0 - Co-surgeons not permitted for this procedure. | 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 | 145 - Treatment, fracture or dislocation of radius and ulna |
| 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. | 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. | 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 | 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 | 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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