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Date Printed: August 23, 2017: 01:41 PM

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This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

02-20000-38

Original Effective Date: 01/15/10

Reviewed: 01/26/12

Revised: 05/11/14

Subject: Thumb Basal Joint Arthroscopy

THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION.

Position Statement Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines
Other References    

DESCRIPTION:

Thumb basal joint arthritis is a common condition which often affects both hands. It is painless or asymptomatic in some people, but others have great difficulty because of pain and weakness of pinch function. Arthritis of the base of the thumb is more common in women than in men, and usually occurs after 40 years of age. Prior fractures or other injuries to the joint may increase the likelihood of developing this condition. Over time, the thumb may get drawn into the palm and be compensated by stretching and hyperextending the adjacent metacarpophalangeal joint. Treatment of arthritis of the thumb basal joint may include conservative treatments such as self-care measures, splints, medication or corticosteroid injections.

Thumb basal joint arthroscopy is proposed as a first step in the treatment and staging of arthritis of the basal joint, from which a determination could be made for the need of other surgical or non-surgical procedures. The following procedures may be recommended based on the arthroscopic findings:

POSITION STATEMENT:

The use of thumb basal joint arthroscopy in the treatment of thumb basal joint arthritis is considered experimental or investigational, as there is insufficient clinical evidence in the published peer-reviewed medical literature to support its effectiveness.

BILLING/CODING INFORMATION:

There is no specific CPT or HCPCS code to report thumb basal joint arthroscopy.

REIMBURSEMENT INFORMATION:

Refer to section entitled POSITION STATEMENT.

PROGRAM EXCEPTIONS:

Federal Employee Program (FEP): Follow FEP guidelines.

State Account Organization (SAO): Follow SAO guidelines.

Medicare Advantage products:

No National Coverage Determination (NCD) and/or Local Coverage Determination (LCD) were found at the time of the last guideline reviewed date.

DEFINITIONS:

No guideline specific definitions apply.

RELATED GUIDELINES:

Thermal Capsulorrhaphy as a Treatment of Joint Instability; 02-20000-23

OTHER:

None applicable.

REFERENCES:

  1. AHRQ National Guideline Clearinghouse. Guideline Summary NCG-6557. Forearm, wrist and hand (acute and chronic), not including carpal tunnel syndrome (2004). Last revised 05/29/08. Accessed 12/15/10.
  2. AHRQ National Guideline Clearinghouse. Guideline Summary NCG-8311. Forearm, wrist and hand (acute and chronic), not including carpal tunnel syndrome (2011). Last revised 05/25/11. Accessed 12/29/11.
  3. American Academy of Orthopaedic Surgeons. Arthritis of the Thumb. Last reviewed and updated July 2007. ©2007. Accessed 12/15/10.
  4. American Academy of Orthopaedic Surgeons. Arthroscopy. Last reviewed and updated May 2010. ©2010. Accessed 12/15/10.
  5. American Society for Surgery of the Hand. Arthritis: Base of the Thumb (2009). ©2010 American Society for Surgery of the Hand. Accessed 12/15/10.
  6. American Society for Surgery of the Hand. 63rd Annual Meeting, Symposium 12: Basal Joint Arthritis: Tried and True and What's New. September 20, 2008. Accessed 12/29/11.
  7. Badia A. Arthroscopic Indications and Technique for Artelon Interposition Arthroplasty of the Thumb Trapeziometacarpal Joint. Techniques in Hand & Upper Extremity Surgery 2008; 12(4): pp 00–00.
  8. Badia A. Arthroscopy of the Trapeziometacarpal and Metacarpophalangeal Joints. The Journal of Hand Surgery 2007; pp 1.
  9. Badia A. Trapeziometacarpal Arthroscopy: A Classification and Treatment Algorithm. Hand Clinics 2006; 22: pp 153–163.
  10. Badia et al. Treatment of Early Basal Joint Arthritis Using a Combined Arthroscopic Debridement and Metacarpal Osteotomy. Techniques in Hand and Upper Extremity Surgery 2007; 11(2): pp 1Y6.
  11. Batra S, Kanvinde R. Osteoarthritis of the thumb trapeziometacarpal joint. Current Orthopaedics (2007) 21, 135–144.
  12. Carro et al. Innovations in Arthroscopic Management of Basal Joint Arthritis of the Thumb. The Journal of Arthroscopic and Related Surgery 2006; 22(12): pp 1361.e1-1361.e4.
  13. ClinicalTrials.gov. Basal Joint Arthritis Prospective (BJAM). NCT01376024. Arthritis Foundation American Society for Surgery of the Hand. Verified on June 2011 by Columbia University.
  14. Croog AS, Rettig ME. Newest Advances in the Operative Treatment of Basal Joint Arthritis. Bulletin of the NYU Hospital for Joint Diseases 2007;65(1):78-86.
  15. Farino GC, Goitz RJ. Thumb trapeziometacarpal joint arthritis: is there a role for arthroscopy? Orthop 2002, 13:256–259 ©2002 Lippincott Williams & Wilkins, Inc.
  16. National Institutes of Health Publication No. 10-4617. National Institute of Arthritis and Muscuoskeletal and Skin Diseases: Osteoarthritis (July 2010). Accessed 12/15/10.
  17. Pegoli et al. Arthroscopic evaluation and treatment by tendon Interpositional Arthroplasty of first carpometacarpal joint arthritis. Hand Surgery 2007; 12(1): pp 35–39.
  18. Schröder J, Kerkhoffs GMMJ, Voerman HJ, Marti RK. Surgical treatment of basal joint disease of the thumb: comparison between resection-interposition arthroplasty and trapezio-metacarpal arthrodesis. Arch Orthop Trauma Surg (2002) 122 :35–38.
  19. Watt AJ, Shin AY, Vedder NB, Chang J. Joint Arthritis and Soft-Tissue Problems of the Hand. Plastic and Reconstructive Surgery. December 2010.

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 01/26/12.

GUIDELINE UPDATE INFORMATION:

01/15/10

New Medical Coverage Guideline.

02/15/11

Scheduled review; position statement unchanged. Updated references.

02/15/12

Scheduled review; position statement unchanged. Updated description section and references.

05/11/14

Revision: Program Exceptions section updated.

Date Printed: August 23, 2017: 01:41 PM