# Can I bill exploration w/procedure? HANDS



## Justarose (May 21, 2009)

Doc did and Exploration of extensor tendons left third and fourth fingers ... Can I bill for this ? What code ? Modifier?

I am thinking the 26437 x3 
but I do not see any code for the exploration ?? 

Here are the notes:

POSTOPERATIVE DIAGNOSIS:
	1.   Extensor tendon sagittal band attenuation. 
        2.   Subluxation of extensor digitorum communis.

PROCEDURES PERFORMED:
	1.   Exploration of extensor tendons left third  
		and fourth fingers.
        2.   Extensor tendon realignment of left third,fourth       and fifth fingers.

An oblique incision was made first over the dorsal hand distal to the extensor retinaculum.  The extensor tendons evaluated in this area were noted to be intact although attenuated.  An incision was made proximal to the extensor retinaculum.  The EDC to middle, ring, and small were also identified, quite patulous.  These were then shortened 0.5 cm with a 4.0 FiberWire.  There was no evidence of rupture proximal or distal to the retinaculum.  We then went distally performing an incision over the dorsal webspace of the third and fourth and then exposed the sagittal band.  The extensor tendon did subluxate over the MP joint and was ulnarly subluxated.  We then reefed the sagittal band, realigning the extensor tendon over the MP joint centrally with multiple sutures.  Once completed realignment to the third and fourth, we then addressed the fifth finger in a likewise fashion.  All wounds were irrigated.  The skin was closed with 4-0 Prolene.  His hand assumed a normal posture.  A splint was applied.  The patient was transferred to the recovery room in stable condition.

Thank You !!


----------



## mitchellde (May 21, 2009)

I do not see an exploration but he does state he shortend the EDC to the middle ring and small fingers
26477 F2
26477 F3
26477 F4
then with separate incision he perform the realignment
26437 F2
26437 F3
26437 F4
I do not remember if these are bundled so you will need to check that and if so use a 59 before the finger modifiers to unbundle since he does state separate incisions.  hope this helps.
Debra


----------

