Summary & Overview

CPT 25240: Excision of Distal Ulna for Wrist Arthritis or Malunion

CPT code 25240 identifies the surgical excision of the distal ulna at the wrist, performed partially or completely to treat pain from arthritis or deformity due to malunion after fracture. Nationally, this code represents a focused orthopedic procedure used to restore wrist biomechanics and reduce chronic pain in affected patients. It is relevant to inpatient and outpatient surgical settings, including hospital operating rooms and ambulatory surgical centers.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is used, typical sites of service, and payer coverage considerations. The publication provides benchmarks where available, summarizes policy and coding guidance relevant to the procedure, and outlines clinical indications and procedural context to aid billing and administrative workflows. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 25240distal ulna excisionwrist surgeryorthopedic surgeryambulatory surgical centeroperating roomarthritis treatmentmalunion repair

Billing Code Overview

CPT code 25240 describes the surgical excision of the distal ulna (wrist end of the ulna), performed partially or completely to address pain from arthritis or to correct malunion from a prior fracture. This procedure involves removing all or part of the distal ulna to relieve joint impingement, improve wrist function, and reduce chronic pain.

Service type: Surgical procedure, orthopedic/wrist surgery
Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A 62-year-old right-hand dominant patient with chronic ulnar-sided wrist pain from posttraumatic malunion of a distal ulna fracture and progressive radiocarpal/ulnocarpal arthritis presents for surgical management. Conservative therapy including immobilization, activity modification, NSAIDs, and corticosteroid injection provided only temporary relief. Imaging (radiographs and CT) demonstrates positive ulnar variance with degenerative changes at the distal radioulnar joint. After preoperative evaluation and informed consent, the patient is scheduled for a distal ulnar excision (ulnectomy) under regional block or general anesthesia in an ambulatory surgical center. The intraoperative workflow includes positioning, sterile prep, longitudinal dorsal or ulnar incision, exposure of the distal ulna, partial or complete excision of the ulnar head/shaft as indicated, irrigation, hemostasis, and layered closure. Postoperative care includes immobilization in a splint, pain control, early hand therapy referral, wound checks, and activity restrictions. Typical sites of service are an ambulatory surgery center or hospital outpatient department for elective procedures; inpatient setting is uncommon unless comorbidities require admission.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/No modifier specified in some payer systems	Use when no specific CMS modifier applies and payer requires a two-character modifier field left blank or with primary code; rarely used clinically.
`52`	Reduced services	Use when the excision is intentionally partially performed with a significant reduction in the extent, duration, or intensity of the service.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to extenuating circumstances prior to completion.
`62`	Two surgeons	Use when two surgeons from different specialties perform distinct portions of the procedure concurrently.
`76`	Data not available in the input.	Data not available in the input.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period for a prior surgery.
`RT`	Right side	Use to specify the procedure was performed on the right upper extremity.
`LT`	Left side	Use to specify the procedure was performed on the left upper extremity.
`22`	Increased procedural service	Use when the work required to perform the ulnectomy is substantially greater than typically required (document rationale).
`52`	Reduced services	Use when the excision is intentionally partially performed with a significant reduction in the extent, duration, or intensity of the service.

Taxonomy Code	Specialty	Notes
207LH0000X	Orthopaedic Hand Surgery	Specialists who commonly perform distal ulnar excision for arthritis or malunion.
207X00000X	Orthopaedic Surgery	General orthopaedic surgeons performing upper extremity procedures.
207W00000X	Surgery of the Hand	Surgeons focused on hand and wrist pathology.
2080S0003X	Plastic Surgery - Hand	Plastic surgeons with hand surgery fellowship training who may perform reconstructive procedures of the distal ulna.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M19.239`	Primary osteoarthritis, unspecified wrist	Degenerative wrist arthritis causing pain that may be treated with distal ulnar excision when localized to the ulnar side.
`M16.0`	Data not available in the input.	Data not available in the input.
`M84.372A`	Data not available in the input.	Data not available in the input.
`S52.201A`	Data not available in the input.	Data not available in the input.
`M21.4`	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`25240`	Excision, distal ulna (Darrach type), partial or complete	Primary procedure: removal of distal ulna to address pain from arthritis or malunion.
`20610`	Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder); without ultrasound guidance	Preoperative diagnostic or therapeutic aspiration/injection of wrist joint or DRUJ for symptom relief or diagnostic confirmation.
`25200`	Arthrotomy, wrist and/or radiocarpal joint; with exploration, debridement, or synovectomy	May be performed in conjunction with ulnectomy if joint debridement is required.
`26010`	Drainage of hematoma, deep, forearm	Postoperative complication management if deep hematoma requires drainage.
`20550`	Injection(s); single tendon sheath, or ligament, aponeurosis	Corticosteroid injection into the distal radioulnar joint or ulnocarpal tissues as prior conservative management.