Surgery: Musculoskeletal System, Interpositional Arthroplasty, 25445, 25447 (Q&A)

 CPT Assistant, August 2021, Volume 31, Issue 8, page 14

Question:

A physician placed a rolled-up piece of allograft tissue in the defect in which the trapezium was excised during an interpositional arthroplasty procedure. An abductor pollicis longus to flexor carpi radialis (APL-to-FCR) suspensionplasty was also performed during the operative session. Would the scenario presented be reported with code 25447 as an interpositional arthroplasty? Or is the rolled-up piece of allograft tissue considered a prosthetic replacement of the trapezium and reported with code 25445?

Answer:

When the trapezium is excised and autologous tissue is utilized between the scaphoid and thumb metacarpal to perform a tendon suspensionplasty, as described in the scenario presented, code 25447, Arthroplasty, interposition, intercarpal or carpometacarpal joints, may be reported. In circumstances in which allograft tissue is the sole interpositional support material without use of autologous tissue (eg, APL-to-FCR suspensionplasty), code 25445, Arthroplasty with prosthetic replacement, trapezium, would be reported.