AHA Coding Clinic® for HCPCS - 2024 Issue 1; Ask the Editor

Carpometacarpal hemiarthroplasty with implant

A patient with osteoarthritis of the right thumb basal joint presented for carpometacarpal (CMC) hemiarthroplasty with implant. An incision was made at the base of the thumb spanning the basal joint. Next, the periosteum over the thumb’s metacarpal base was incised and elevated off the base lifting up the joint capsule and the abductor pollicis longus tendon. An oscillating saw was used to remove a 7 mm slice off the base of the thumb metacarpal. The flexor carpi radialis tendon was identified and released. A curved elevator, osteotome, rasps and shaping tools elevated the joint capsule off the undersurface of the trapezium removing the trapezial ridge/osteophytes allowing the implant to slide under the trapezium. A size 3 implant was trialed in the thumb metacarpal. The range of motion was excellent with no instability. The trial was removed and the permanent implant was impacted to the base of the thumb metacarpal. Hemostasis was obtained and the periosteum was repaired back to the base of the metacarpal with sutures. The skin was closed and a bulky thumb Spica was applied. The patient was taken to PACU. CPT code 25447 does not seem appropriate in this case, since the code is for an interposition arthroplasty and the patient had a partial joint replacement. How is a hemiarthroplasty with implant coded? ...

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