Summary & Overview
CPT 24160: Removal of Elbow Prosthesis, Humeral and Ulnar Components
CPT code 24160 captures the surgical removal of a previously implanted elbow prosthesis that includes both humeral and ulnar components. This explantation code is clinically important because it records complex revision procedures that can arise from prosthesis failure, infection, loosening, or pain. Proper coding of explantation procedures affects quality measurement, resource use tracking, and national procedure volume estimates.
Key payers considered in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for elbow prosthesis removal, common sites of service, and the implications of coding this service for billing and aggregate tracking. The publication also summarizes how payers approach coverage and billing for explantation procedures, bench-marking expectations, and relevant policy considerations.
This report provides benchmarks where available, national policy updates that affect surgical explantation billing, and practical context for clinicians and revenue cycle staff who document and submit claims involving elbow prosthesis removal. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 24160 describes the surgical removal of a previously implanted elbow prosthesis that includes both a humeral component and an ulnar component. This procedure involves explantation of the prosthetic components from the elbow joint and is classified as an orthopedic revision/explant service.
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Service type: Surgical explantation of elbow prosthesis
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a long-standing total elbow arthroplasty presents with progressive pain, loosening, and recurrent instability of the elbow prosthesis. Imaging demonstrates radiographic loosening of both humeral and ulnar components with osteolysis and periprosthetic lucency, and the patient reports decreased function and recurrent joint effusions. The orthopedic surgeon schedules removal of the elbow prosthesis under general anesthesia in an operating room setting. Preoperative workflow includes history and physical, review of imaging (X-ray and CT as needed), discussion of expected blood loss and potential need for revision arthroplasty or staged reimplantation, antibiotic prophylaxis, and obtaining informed consent. Intraoperative steps include exposure of the elbow via prior incision, careful removal of humeral and ulnar components, debridement of fibrous tissue and cement if present, management of bone defects, irrigation, and placement of a spacer or plan for definitive revision if applicable. Postoperative workflow includes pain control, immobilization or splinting as indicated, neurovascular checks, discharge planning with physical therapy ordering, and follow-up for wound check and planning for revision reconstruction if staged treatment was chosen. Typical site of service is an inpatient or ambulatory surgical center operating room depending on patient comorbidities and expected complexity. The service type is a major surgical procedure (open implant removal) consistent with orthopedic surgery for the elbow.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, additional procedure professional component | Use for the usual, uncomplicated service when payer requires explicit reporting of the primary service. |
22 | Increased procedural services | Use when work required is substantially greater than typically required (extensive debridement, prolonged operative time). |
23 | Unusual anesthesia | Use if general anesthesia is not planned but patient requires more intensive anesthesia due to severe systemic disease. |
26 | Professional component | Use when reporting only the surgeon's professional component separate from technical facility billing (rare for operative codes billed by surgeon). |
51 | Multiple procedures | Use when additional distinct procedures are performed in the same operative session alongside implant removal. |
52 | Reduced services | Use if the procedure is partially reduced or aborted for documented reasons. |
53 | Discontinued procedure | Use when procedure is terminated after anesthesia due to patient safety or unexpected findings. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons for distinct, documented portions of the procedure. |
76 | Repeat procedure by same physician | Not in provided list; excluded. |
78 | Unplanned return to OR for a related procedure during the postoperative period | Use if the patient returns to the operating room for a complication related to the initial implant removal. |
80 | Assistant surgeon | Use when a surgical assistance is provided by an assistant surgeon. |
81 | Minimum assistant surgeon | Use when a physician assistant provides minimal assistance as defined by payer policy. |
82 | Assistant surgeon (when qualified resident unavailable) | Use when a qualified resident is unavailable and an assistant is required. |
LT | Left side | Use to indicate the left elbow when laterality is required by payer. |
RT | Right side | Use to indicate the right elbow when laterality is required by payer. |
QX | CRNA service with medical direction by physician | Use when a certified registered nurse anesthetist provides service with medical direction elements. |
QY | Medical direction of two or more independent anesthesia providers | Use when the anesthesiologist medically directs multiple CRNAs during the case. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207X00000X | Orthopedic Surgery | Primary specialty performing elbow implant removal and revision procedures. |
207L00000X | Hand Surgery (Orthopedic) | Surgeons with hand/elbow focus commonly perform complex elbow revisions. |
2086S0102X | Physical Medicine & Rehabilitation | Manages pre/postoperative rehabilitation and functional recovery planning. |
207K00000X | Sports Medicine (Orthopedic) | May be involved in complex elbow joint care and revision planning. |
208000000X | General Surgery | Occasionally involved for complex wound or soft-tissue management (less common). |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M24.241 | Recurrent dislocation, left elbow | Prosthesis instability may prompt removal and revision. |
M24.242 | Recurrent dislocation, right elbow | Same relevance for right-sided prosthesis instability. |
T84.04XA | Dislocation of internal prosthetic joint, initial encounter, elbow | Directly indicates prosthetic joint dislocation requiring implant management. |
T84.042A | Dislocation of internal prosthetic joint, subsequent encounter, elbow | Used for follow-up encounters related to prosthetic dislocation. |
T84.518A | Infection and inflammatory reaction due to other internal joint prosthesis, initial encounter | Periprosthetic joint infection is a common indication for implant removal. |
M84.4X9A | Pathological fracture, unspecified site, initial encounter | Periprosthetic fracture around elbow components may necessitate implant removal. |
M87.351 | Osteonecrosis due to previous trauma, left elbow | Severe bone loss/necrosis can compromise implant fixation and require removal. |
M19.041 | Primary osteoarthritis, right elbow | Progressive arthritic changes or implant failure may lead to revision and implant removal. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
24160 | Removal of implant; elbow, including humeral and ulnar components | Primary procedure: removal of previously implanted elbow prosthesis with humeral and ulnar components. |
24360 | Revision, total elbow arthroplasty, each component (humeral or ulnar) | May be performed during same or staged admission to replace removed components when planning definitive revision. |
20680 | Removal of deep implant; e.g., buried wire, pin, etc. | Used when removal of other deep hardware or retained fixation devices is required at the time of prosthesis removal. |
11042 | Debridement; skin, subcutaneous tissue, and muscle, first stage wound | Applied when extensive debridement of infected or necrotic soft tissue is performed during implant removal. |
20690 | Arthrotomy for removal of foreign body; elbow | May be used for removal of retained prosthesis components or cement fragments not encompassed by the implant removal code. |
20611 | Arthrocentesis, aspiration and/or injection, major joint or bursa (without ultrasound guidance) | Used preoperatively for joint aspiration to evaluate infection or postoperatively for joint management. |