# Trigger finger vs. Tenosynovectomy



## wmcodylee (Jun 16, 2017)

Possible a dumb question. Can someone explain the difference between trigger finger release and tenosynovitis. I actually know the difference, but the op note is a little confusing.

Pre-op DX: Index, Long, Ring, and Small flexor tenosynovitis 

Post op DX: Index, Long, Ring, and Small A1 pulley release and flexor tenosynovectomy. 

Procedure: Index, Long, Ring, and Small A1 pulley release and flexor tenosynovectomy. 

Procedure: A 15 blade was used to make a transverse incision to level of A1 pulley. This was carried down to subcutaneous tissue using tenotomy scissors. The neurovascular bundles were identified on each side of the fiber osseous sheath and retracted with nerve retractors placed within the confines of the wound. Once the A1 pulley was identified, an axial incision was made in the midline of it dividing it completely. This was carried proximally and distally with tenotomy scissors. Tenotomy scissors were used to perform FLEXOR TENOSYNOVECTOMY for the index, long, ring and small fingers. After this was done again the neurovascular bindles were inspected and found to be intact. The Ragnell retractor was used to pull the tendon into the wound to ensure that it had been completely released from the pulley. The tourniquet was let down. Sterile dressing was applied. 

I realize it says the Dr. checked to see that the tendon was released from the pulley, but wouldn't I code for the tenosynovectomies (26145) and use tenosynovitis (m65.842) as my DX? The A1 pulley release cpt code is 26055 is for trigger finger. And trigger finger and tenosynovectomy are inclusive of each other. For the office visits prior to the surgery the Dr. is using the trigger finger dx. So what should I be coding this as?


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## daedolos (Jun 19, 2017)

The tendon release is a cutting of the A1 pulley (most of the time) while the tenosynovectomy involves removing a portion of the tendon sheath.

Peace
@_*
Your three Dx should be for the two trigger fingers and the tenosynovitis.  Hope that helps.


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## AlanPechacek (Jun 24, 2017)

Historically/traditionally, in Orthopedic Surgery, "Trigger Finger" is also called "Stenosing Tenosynovitis of the Flexor Tendon."  However, ICD-10 does not use this terminology, but gives the alternative term "Nodular tendinous disease," which is not necessarily incorrect, but it is not a term that most US Orthopedic/Hand/Plastic Surgeons would use.  In my experience of dealing with this problem, the tendon becomes swollen ("tendinitis") and won't slide back and forth as the finger is flexed and extended.  It hangs up or gets caught (sometimes to the point of "locking" the finger in a flexed position) at the "A1 Pulley" at the base of the finger.  The surgical procedure "Trigger Finger Release," called Tendon Sheath Incision (26055) in CPT, cuts the tendon sheath at the A1 Pulley to open it up so the tendon will slide without getting hung up anymore.  When the affected tendon is examined, it will usually be found to be swollen.  In making certain that the "release" is complete and successful, the tendon is lifted from its tendon sheath to make sure it is free.  Sometimes there are synovial adhesions of the tendon (the "Tenosynovitis") that need to be broken up or surgically debrided/removed (the "Tenosynovectomy").  Finding large quantities of proliferative synovitis (also Tenosynovitis) around the tendon is extremely rare such that an "extensive tenosynovectomy" of that tissue would also be rare.  From my perspective, the Trigger Finger Release/Tendon Sheath Incision procedure "includes" whatever treatment (release and/or debridement) of the synovial adhesions is done, and to also charge for a separate "Tenosynovectomy" is improper.

I hope this discussion of this disorder is helpful.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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## daedolos (Jul 10, 2017)

Thank you, again, for that clarification.

Peace
@_*


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