# trigger finger release and tenosynovectomies?



## peporter (Jun 22, 2009)

Hello coders, I need help determining when a 26145 is billable when trigger finger release is done. The CCI edits say the 26055 is part of 26145. If the patient has trigger thumb and left ring finger trigger finger and while the surgeon is doing the surgery he states the the patient has some thick tenosynovium here that was debrided around both the flexor digitorum sublimis and flexor digitorum profundus tendons throughout the palm. If he gives a post-op diagnosis of tenosynovits of flexor tendons, is this billable or considered incidental? What determines when the 26145 is billable? I read in the AAOS global book under 26055 that the 26145 is incuded except for  a different pathological diagnosis. Is there an easy answer somewhere to this or am I making this more confusing than it is? I would really appreciate some feedback on this...thanks ..Paula in Dublin, Ohio


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## JMeggett (Jun 23, 2009)

That's a tricky one.  I would bill the 26145, 26055-59-FA, 26055-59-F3 and then make sure to attach appropriate Dx's to each code.  You risk the carrier bundling the trigger fingers but they should be appealed with Op note.  
Jenna


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## peporter (Jun 23, 2009)

Jenna, thanks for your answer..it is so confusing with these hand surgeries..the surgeon seems to do a lot of the 26145 with hand procedures and with carpal tunnel procedures too. That how I was planning on submitting the charge but I appreciate a second opinion. I suppose it all depends on how well he documents the surgery. Thanks so much, Paula


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## mbort (Jun 23, 2009)

be careful with these..."most" of the time its for visualization and therefore would not be seperately reportable.  Make sure your documentation is going to support the -59 modifier.

Mary, CPC, COSC


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## peporter (Jun 25, 2009)

Mary, so he needs to have the separate diagnosis to support the 59 modifier or since he sends a sample to pathology, do I need to have a supporting pathology report? Paula


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## mbort (Jun 25, 2009)

yes, it should be something along the lines of hypotrophic synovium.  If its straight synovitis, at least for my guys, I do not allow it as I dont feel the -59 is justified.  Like I mentioned earlier, usually they do the tenosynovectomy/synovectomy for visualization purposes only therefore thats why it bundles.  Just make sure you have documentation that strongly supports the -59 modifier.

Hope this helps
Mary, CPC, COSC


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## martnel (Jun 25, 2009)

I agree with Mary, I never do those codes together unless I have a seperate diagnosis.  The CodeX software also shows that 26055 is included in the 26145 (GSD - Global service Data) and it also shows that you need a modifier in CCI edits.


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## peporter (Jun 25, 2009)

Thank you both for your help. Paula


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## rcbaker (Dec 28, 2010)

*trigger finger release*

the coders are coding 26145 for open thumb trigger release, but I come up with 20655.

Op Note:

1. Flexor pollicis longus tendolysis
2. Flexor tenosynovectomy

 Attention was directed to the thumb. An incision was marked out and made about the palmar digitial crease at the base of the thumb transveresly taking care  to just divide through the dermis. Little scissors where then used to bluntly spread the soft tissues. The radial  digital  nerve was identified in its usual anatomic position lying obliquely just proximal to the A1 pulley.  The ulnar digital nerve was identified. These nerves where kept under direct visualization or  protected by cast and retractor throughout the entire procedure. Kasadan retractors were  then used to very gently retract the digital nerves and the A1 pulley was divided and flexor  tendon sheath entered. Flexor pollicis longus tendolysis was performed with sharp dissection and  proliferative flexor tenosynovium was excised. Flexor pollicis longus was then able to glide freely.   Both digital nerves were inspected and noted to be intact, uninjured and normal  in appearance.

Physician stated he did a open thumb trigger release.
coders coded 26145 and 26440


Please advise on coding above, should it be a26055?

What is the difference between 26055 and 26145???

Thanks for your help in advance.


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## rcbaker (Dec 28, 2010)

*trigger finger release*

the coders are coding 26145 for open thumb trigger release, but I come up with 20655.

Op Note:

1. Flexor pollicis longus tendolysis
2. Flexor tenosynovectomy

 Attention was directed to the thumb. An incision was marked out and made about the palmar digitial crease at the base of the thumb transveresly taking care  to just divide through the dermis. Little scissors where then used to bluntly spread the soft tissues. The radial  digital  nerve was identified in its usual anatomic position lying obliquely just proximal to the A1 pulley.  The ulnar digital nerve was identified. These nerves where kept under direct visualization or  protected by cast and retractor throughout the entire procedure. Kasadan retractors were  then used to very gently retract the digital nerves and the A1 pulley was divided and flexor  tendon sheath entered. Flexor pollicis longus tendolysis was performed with sharp dissection and  proliferative flexor tenosynovium was excised. Flexor pollicis longus was then able to glide freely.   Both digital nerves were inspected and noted to be intact, uninjured and normal  in appearance.

Physician stated he did a open thumb trigger release.
coders coded 26145 and 26440


Please advise on coding above, should it be a26055?

What is the difference between 26055 and 26145???

Thanks for your help in advance.


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