# Excision of Gouty Tophys-Interphalangeal joint



## coderguy1939

Anyone have any experience with coding excision of a tophus at the interphalangeal joint for gouty arthritis?  I'm looking at 26808.


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## dmaec

I don't see the code (26808) you wrote - but I guess I'd lean towards 28092 with the info you've given.


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## coderguy1939

Sorry, I transposed the numbers.  Should be 26080.


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## dmaec

oh, I see - so did the doc do an "incision" into the joint or an "excision" of the lump on the patients toe due to gouty arthritis?


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## coderguy1939

The diagnosis was gouty tophus of the interphalangeal joint of the little finger and the op report states a longitudinal incision over the PIP joint and the tophaceous material was removed by rongeur and scissors.


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## dmaec

I still like the 28092 for that then.


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## mbort

The 28092 is for the foot so I wouldnt recommend that code.  

I think that the 26080 will work..maybe..did he mention entering the joint or just that the incision is over the joint???


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## dmaec

argh! I had "toe" in my head! so yes the 28092 is incorrect! sorry about that!
but, I'm still not quite convinced the 26080 is correct, because isn't that an incision "into" the joint? or am I reading too much into the code?


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## coderguy1939

No, he does not say that he has gone into the joint, but says that upon incision gouty tissue was immediately encountered from the PIP joint and was removed by rongeur and scissors.  The only other alternatives seem to be 26115, 26210 or debridement.


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## mbort

You should probably query the surgeon, I will bet you that he irrigated the joint but didnt document, especially when there is gout expressed from the joint. 26080 would be the appropriate code if you can get that clarified.  

If for some reason he didnt, then I would use the debridement codes 11042/11043/11044 as appropriate.


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## dmaec

*sighs* I just don't know on this one   I'd have to talk to the physician.  I'm not sure what they meant by what they wrote.  I have a feeling this is just a basic incision/drainage type of thing.  For relief of pain.. 
I'm just not sure...


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## coderguy1939

Thanks for all the input.


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