Summary & Overview
CPT 25920: Surgical Separation of Hand at Wrist
CPT code 25920 represents surgical separation of the hand from the forearm at the wrist joint — a wrist-level amputation. This code is used to document and bill for definitive amputation procedures of the hand performed in operative settings. Nationally, wrist-level amputations are significant for trauma care, management of severe infection or ischemia, and certain oncologic or reconstructive scenarios, making accurate coding important for clinical tracking and reimbursement.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service captured by 25920, the typical care setting for the procedure, and the common billing modifiers associated with upper-extremity surgical claims (input lists). The publication provides benchmarks and coding context where available and notes when input data is not provided. It also outlines clinical and administrative considerations relevant to claims submission and payer coverage determinations, including typical sites of service and the procedural nature of the code. Data not available in the input will be identified as such in the relevant sections of the full publication.
Billing Code Overview
CPT code 25920 describes a surgical procedure in which the provider separates the hand from the forearm at the wrist joint. This procedure is a form of upper extremity amputation performed at the wrist level.
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Service type: Surgical amputation of the hand at the wrist joint
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Typical site of service: Inpatient or outpatient surgical setting, such as an operating room or hospital surgical suite where major limb surgery is performed.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old with a non-replantable traumatic wrist-level injury from industrial machinery or an extensive distal forearm malignancy requiring removal of the hand at the wrist. The patient presents to the emergency department or preoperative clinic with an unsalvageable hand, severe crush injuries, or tumor invasion involving wrist joint structures and neurovascular bundles. Initial workflow includes triage, hemodynamic stabilization if needed, radiographic assessment (wrist and forearm X-rays, CT if complex), neurovascular exam documentation, informed consent discussing expected loss of function and prosthetic options, and coordination with hand surgery or orthopaedic/plastic surgery teams.
Surgical care involves preoperative marking, general or regional anesthesia, tourniquet use as indicated, and wide exposure of the wrist joint. The procedure includes disarticulation at the radiocarpal joint or through the wrist joint, careful management of tendons, nerves, and blood vessels, creation of a soft-tissue envelope suitable for closure or flap coverage, and hemostasis. Postoperative workflow includes pain control, wound care, antibiotics as indicated, DVT prophylaxis, early occupational therapy referral for stump care and prosthetic planning, follow-up visits for wound assessment, and potential staged reconstruction or prosthetic fitting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no special circumstances apply. |