CPT® Code 25900

The CPT® Code 25900 refers to the surgical procedure of amputation of the forearm, specifically through the radius and ulna bones. This procedure is categorized as a below-elbow amputation, which can be performed at various levels: high, middle, or low. A high amputation occurs a few centimeters below the elbow joint, a middle amputation is executed through the shafts of the radius and ulna, and a low amputation is performed a few centimeters above the wrist. During the procedure, the patient is typically positioned with the operative side's shoulder slightly elevated to facilitate access to the forearm. The surgical team marks the incision lines for the skin and muscle flaps on the patient's skin, often utilizing an anterior/posterior fish-mouth flap technique. The incision is made perpendicular to the skin surface, allowing for the careful dissection of underlying soft tissue, where blood vessels and nerves are identified and managed. This meticulous approach ensures that large blood vessels are mobilized, ligated, and divided appropriately, while nerves are also mobilized, doubly ligated, and divided to allow for retraction into the muscle tissue. The procedure involves exposing the radius and ulna, creating periosteal flaps, and transecting the bones at the level of these flaps, ensuring that both bones are of equal length. The remaining bone is then covered with sutured periosteal flaps, and antagonistic muscle groups are sutured together and anchored to the periosteum, enveloping the remaining bone in muscle tissue. To enhance stability, muscle sutures may be reinforced with synthetic tape. After the amputation, drains are placed, and the subcutaneous fascia and skin are closed around these drains. A rigid dressing is applied to the site to minimize pain and prevent edema, ensuring optimal recovery conditions for the patient.