A mid-carpal arthrodesis with scaphoid excision was performed due to left wrist radioscaphoid and mid-carpal arthritis. After the incision was made and dissection was taken down to the carpal joint, the scaphoid was fragmented and removed. The lunate was brought into neutral tilt and temporarily pinned. Demineralized bone matrix (DBM) allograft putty was placed into the mid-carpal articulation and the remainder of the hardware was placed. Since bone bank graft and bone graft substitutes are generally inherent to musculoskeletal procedures and not separately reported, is it appropriate to assign CPT code 25820, Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal), for the intercarpal fusion? Or since the narrative of code 25820 specifically states “without bone graft” is the assignment of an unlisted code more appropriate?
Assign CPT code 25820, Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal), for the arthrodesis with demineralized bone matrix allograft putty. Append modifier LT, Left side, to indicate laterality. Even though demineralized bone matrix was utilized, the use of DBM is not generally reported separately. In this case, it is appropriate to assign CPT code 25820 to capture the wrist arthrodesis. For facility reporting, the DBM can be reported with the appropriate revenue code.