# Excise Mucous Cyst & debride osteophytes left ring finger DIP Joint



## Joyce Burchett (Aug 10, 2018)

Radiographic Findings consistent with mucous cyst & significant degenerative arthritis in the DIP joint. 

Op Report: A curvilinear incision was made over dorsum of the left ring finger DIP joint. Dissection was carried through subcutaneous tissue. Full-thickness skin & subcutaneous tissue flaps were elevated. The mucous cyst was localized pretty centrally over the extensor mechanism distal to the DIP joint. The cyst was identified & mobilized & excised and originated from the dorsal ulnar corner of the joint.  Both the dorsal Ulnar & dorsal Radial corner of the joint were identified & osteophytes were debrided with a rongeur off the base of the distal phalanx.  The penrose drain was removed & bleeding controlled with electrocautery. The incision was irrigated & closed.

Coded with 26210 & 26160.  One of our coders says per Margie Vaught that this is how we should be billing these.  I feel that 26160 would include the debridement of the osteophytes since all through same incision.  Can anyone advise on this issue.  I found several questions similar to this, but am confused on why would these billed together when done through same incision.  CPT Code 26210 is a Column 1 code with 26160 being a column 2 code, but unbundling is allowed.  Thanks in advance for anyone who may be able to help.


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## fish4codes (Aug 13, 2018)

Being a coder for hand surgeons, oh how I wish this were a clear cut singular code, as it is does so very frequently.  I still take pause when coding this, but after much research, reading many varied opinions and asking myself on this site - I code 26235 or 36 for the osteophyte and depending on the documentation will add 26160 with modifiers.   Refer to previous post on this forum from 11/2/17 with the title "Excision of Osteophyte from DIP 26080 vs 26236 vs 26210". I would like to see the written info from Margie Vaught if you have a link to this.  Hope this helps and doesn't add to the confusion...


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## sxcoder1 (Aug 14, 2018)

I always code osteophytes as excision or curettage of bone cyst or benign tumor and not partial excision (craterization, saucerization) bone.  See the following link  http://medcodingforum.decisionhealth.com/discussion/1331/excision-of-osteophyte with info from Margie Vaught.  I have also read and researched a lot on this topic.  It's confusing!


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## fish4codes (Aug 14, 2018)

It is terribly confusing.  I have referenced this from Supercoder:  https://www.supercoder.com/my-ask-an-expert/topic/excision-of-osteophyte-and-mucous-cyst  and also rom an AAPC thread where Dr. Pechacek weighs in that an "osteophyte is not a bone cyst" (ref: https://www.aapc.com/memberarea/forums/152730-excision-osteophyte-dip-26080-vs-26236-vs-26210-a.html) in it he states,  "The osteophyte of the distal phalanx is neither a bone cyst nor a benign tumor of the phalanx, so 26210 does not apply. You are left with 26160 and 26236 plus a Modifier, probably 51 for Multiple Procedures."    Again - I wish there were a specific code for this very common hand surgery !!  All I do know is that I have received payment for 26235 and 26160, 59,51 ...


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## iowagirl77 (Aug 14, 2018)

I agree, it is confusing. I only bill the 26160. My thoughts on it are that it bundles with any of these other codes that are being suggested here. Since it bundles and is through the same incision I would not bill both codes. I go with 26160 because ultimately the excision of the mucous cyst is what my provider is trying to accomplish; the osteophyte excision seems incidental.


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