Summary & Overview
CPT 24164: Removal of Elbow Prosthesis With Radial Component
CPT code 24164 defines the surgical removal of a previously implanted elbow prosthesis when the implant includes a radial component. This procedure code captures revision or explantation services specific to the elbow joint and is used in billing for operative care where an implanted radial-bearing component is explanted. Nationally, accurate use of this code matters for clinical documentation, correct surgical coding, and consistent reimbursement across payers for orthopedic implant management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for elbow implant removal, typical sites of service, and what to expect in coding practice. The publication outlines common billing considerations, benchmarking context where available, and policy or coverage themes relevant to explantation procedures.
This summary equips coding professionals, surgeons, and billing staff with a concise reference to the code’s clinical meaning, common administrative considerations, and where to look for payer-specific guidance. Data not available in the input prevents presentation of payer-specific rates or utilization metrics; readers will find guidance on typical documentation elements and the broader policy relevance of explantation coding.
Billing Code Overview
CPT code 24164 describes the surgical removal of a previously implanted prosthesis from the elbow joint when the implant being removed includes a radial component. The service type is a surgical implant removal procedure focused on the elbow, and the typical site of service is an inpatient or outpatient surgical setting such as an operating room or ambulatory surgery center depending on clinical circumstances.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old individual with a history of elbow arthroplasty who presents with progressive pain, loosening, recurrent instability, or infection around a previously implanted elbow prosthesis that includes a radial head or radial component. The patient may report worsening pain, decreased range of motion, mechanical catching, or signs of wound drainage or systemic infection. Preoperative evaluation includes history and physical, radiographs of the elbow, CT if needed to assess component loosening or bone loss, and laboratory studies (CBC, ESR, CRP) when infection is suspected. The surgical workflow for 24164 involves removal of the implanted elbow prosthesis radial component under general or regional anesthesia in an operating room or ambulatory surgery center. The procedure typically requires exposure of the elbow joint through the prior incision, dissection to the prosthesis, removal of the radial component (and often associated components if indicated), assessment and management of bone loss, irrigation, and possible placement of an antibiotic spacer if infection is present. Postoperative care includes pain control, wound care, immobilization versus early protected motion per surgeon protocol, and follow-up imaging and clinic visits. This service is commonly billed when the radial component of an elbow prosthesis is the implant being removed and may occur as an isolated implant removal or as the first stage of a revision arthroplasty procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |