# Tenosynovectomy of APL/EPB for De Quervain's Disease



## Charmaine-Grace.Ruiz@Sourcehov.com (Aug 10, 2014)

I would like to hear your thoughts on how to code the op report below:


_Landmarks were identified and a small incision was made over the right de Quervain's site of the first dorsal compartment. Dissection was carried down through subcutaneous tissue. Hemostasis was achieved with the use of electrocautery. Identification of the soft tissue covering over the first dorsal compartment was mobilized out of the way and exposed the first dorsal compartment. This was dissected free proximally and distally subcutaneously to the site of the suprafascial level. At this point the tendon sheath covering was easily identified and this was opened through the APL through a tenovaginotomy. Dissection was carried out proximally and distally releasing the tendon sheath in total and the tendon was placed on tension. Tenosynovectomy was performed removing the synovial tissue and direct visualization of the tendon showed that it was intact and there was no damage to it. There was no other compartment than this one. Next the CPU was identified. Incision was made In the compartment of the EIPB through a tenovaglnotomy. Dissection was carried out proximally and distally, releasing the tendon sheath. At this point the EPB tendon was placed on tension. 

Tenosynovectomy was performed and the tendon was inspected. There was no damage to it There was no other hidden compartment either identified. Both tendons were mobilized put of the way. There was no other compartment seen. than this one. The wound was irrigated with normal saline and dried. Hemostasis was achieved with the use of the cautery. 

The wound edges were approximated with the use of 04.0 Prolene Interrupted vertical mattress sutures. 

Next, attention was turned to the KR tendon sheath. Mini-Incision was made over the FCR tendon sheath. Dissection was carried out through the subcutaneous tissue. Hemostasis was achieved with the use of a cautery. Identification of the FCR tendon sheath was identified and suprafascial dissection was performed proximally and distally, identifying the sheath in total. The sheath was opened through a tenovaginotomy. Dissection was carried out proximally and distally, releasing the sheath in total and the FCR tendon was placed on tension. Tenosynovectomy was performed and there were no masses In this tendon sheath. At this point the wound was irrigated with normal saline and dried. The skin was closed with 04-0 Prolene Interrupted vertical mattress sutures. 

Injection of liquid allograft was performed to both sites to decrease scarring and to promote healing and decrease the pain. Once the AmnioFix injection was placed in both wound sites, 10 cc 0.5% Naropin was Injected into both wound sites, 5 cc at each site._


What would be the difference between CPT codes *25116* (Radical excision of bursa, synovia of wrist, or forearm tendon sheaths extensors, with or without transposition of dorsal retinaculum), and *25118* (Synovectomy, extensor tendon sheath, wrist, single compartment) in the light of tenosynovectomy of the wrist extensors?

I had the impression that if it is specified as "TENO"synovectomy or "RADICAL" synovectomy of the wrist, I should use 25116, otherwise, it would be coded as 25118. This is consistent to what I get whenever I use the 3M encoder. However, I saw the April 2012 CPT Assistant article that states that it is appropriate to report code 25118 if the physician performs a tenosynovectomy of the first dorsal compartment for De Quervain's tenosynovitis and removes all of the diseased tissue. Would this be the case if the Op report shows tenosynovectomy of both EPB and APL (each tendon being described individually, and not simply referred to as the "1st dorsal compartment") for de Quervain's? If so, when would 25116 be used then?


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## Charmaine-Grace.Ruiz@Sourcehov.com (Aug 12, 2014)

Any help on this? I am really confused between 25116 and 25118.


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## MOHANSAI123 (Jun 16, 2016)

*iam so confused  can i code 26460 along with the 25118 for tenovaginotomy*

iam so confused with tenovaginotomy alnog with proliferative tenosynovectomy can u pls help regarding codes when dx was ist dorsal compartment stenosing tenosynovectomy


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