Summary & Overview
CPT 25136: Carpal Bone Excision with Allograft Reconstruction
Headline: CPT code 25136 defines carpal bone excision with allograft reconstruction, a targeted surgical procedure for benign wrist lesions
Lead paragraph: CPT code 25136 represents surgical exposure of the carpal bones to remove benign cysts or tumors and repair the resulting defect using a graft taken from another human donor. The code captures a specialized orthopaedic hand/wrist procedure with implications for surgical coding, facility resource use, and payer authorization.
Why it matters: This code is important nationally because it documents a distinct operative intervention that combines tumor or cyst excision with allograft reconstruction. Accurate use affects surgical quality reporting, claims adjudication, and appropriate reimbursement for procedures performed in hospital operating rooms and ambulatory surgical centers.
Key payers covered: Analysis typically addresses major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides clinical context for the operative service, coding nuances for CPT code 25136, expected sites of service, and common modifiers used in practice. It highlights benchmarking considerations and payer coverage patterns where available. Data not available in the input will be noted as such; the focus remains on clinical description, coding specificity, and the operational settings in which the procedure is delivered.
Billing Code Overview
CPT code 25136 describes the surgical exposure of the carpal bones of the wrist with excision of a benign cyst or tumor and reconstruction of the resulting defect using a graft harvested from another human donor. This procedure involves removal of a benign growth from the carpal bone(s) and placement of an allograft to repair the bony defect created by the excision.
-
Service type: Surgical excision with reconstruction using an allograft
-
Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 45-year-old right-hand dominant patient presents with a symptomatic dorsal wrist ganglion originating from the scapholunate joint. The patient reports progressive pain, mechanical catching, and a visible soft-tissue swelling over the dorsal wrist that limits activities of daily living despite conservative care including splinting and steroid injection. Imaging (wrist radiographs and MRI) confirms a benign cystic lesion adherent to carpal bones without aggressive bone destruction.
Preoperative workflow includes history and physical, informed consent discussing excision and possible reconstruction with an autograft, preoperative labs as indicated, and anesthesia clearance. In the operating room under regional or general anesthesia, the surgeon exposes the carpal bones, excises the cyst/tumor, and repairs the resultant defect using autologous bone or soft-tissue graft harvested from the patient. Hemostasis is achieved, wounds closed, and a sterile dressing and immobilization applied. Postoperative workflow includes PACU recovery, pain control, short-term immobilization, wound checks, and referral to hand therapy for progressive range of motion and strengthening as indicated. Typical follow-up occurs at 1–2 weeks for wound evaluation and at 6–12 weeks for functional assessment and radiographic healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work, time, and effort substantially exceed typical for the procedure due to complexity or extensive dissection. |