CPT® Code 25215

The procedure described by CPT® Code 25215 refers to a carpectomy involving the excision of all bones in the proximal row of the carpus, which is the wrist joint. The carpus is composed of eight small bones arranged in two rows, with the proximal row consisting of the pisiform, triquetrum, lunate, and scaphoid (navicular) bones. This surgical intervention is typically indicated for conditions such as scapholunate advanced collapse (SLAC), which can arise from chronic scapholunate dissociation or untreated scaphoid nonunion, leading to osteoarthritis and subluxation of the wrist joint. Other reasons for performing this procedure include dorsiflexion instability, nonunion of the scaphoid accompanied by carpal instability, failed prosthetic replacement of the lunate, and Kienbock's disease. The surgical approach involves making a longitudinal incision on the dorsal aspect of the wrist, allowing for the careful exposure of the proximal carpal bones while preserving important ligaments, such as the radioscaphocapitate ligament. The excision process involves using a rongeur to remove the middle portions of each bone, which facilitates their collapse inward, followed by the careful removal of the remaining proximal and distal aspects. After the procedure, the incision is closed in layers, and the wrist is immobilized in a cast to promote healing.