# Gouty Tophus Excision - Hand/phalanx



## fish4codes (Sep 20, 2018)

This question has been bounced around a bit, but I am not 100% convinced my coding is correct on this one:   OP note states, "..incision carried to the subcu, gouty tophus was encountered and removed with scissors and curette.  The tophus was within the DIP joint and within the distal phalanx itself.  Extensor tendon intact, but base of distal phalanx thinned.  Once tophus had been debrided and cultures taken, wound was irrigated, etc..."     Because he doesn't document removing bone I'm thinking 26116 (reasoning, he went to bone so it would have to be subfascial).  I am going to query and if he DID remove bone with this  my bigger question is, would 26262 be more appropriate than 26236  (CPT Lay describes 26262 ..."The bone and surrounding tissues are resected.")  
I appreciate thoughts on this one!  Thank you ...


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