# Excision of Osteophyte from DIP 26080 vs 26236 vs 26210



## MI_CODER (Oct 31, 2017)

Hello,

I would greatly appreciate another coder's opinion on how they would code the following op report? 

A longitudonal incision was made from the nail fold proximally in the midlateral line after elevating the upper nail fold from the nail plate with a freer elevator.  A full thickness skin flap was then elevate off the nail plate and the extensor tendon exposing the mucous cyst.  The mucous cyst was excised from the flap and we then approached the distal interphalangeal joint (DIP).  An elliptical piece of capsule was excised overlying the DIP joint.  The joint was debrided of any osteophytes and loose bodies.  We then irrigated the joint, inspected the extensor tendon which was intact and proceeded with closure with a 5-0 nylon suture.

I came up with 26160 and 26080. Because there is a CCI edit between these two codes, I would only code for 26160 since both procedures were done in the same area. However, the provider disagrees with 26080 and feels that 26236 is the correct code.

Based on the op report, I still believe the correct code is 26080 but now I'm doubting myself because I've done research and see people suggesting 26236 or 26210 for the osteophyte excision..

Thank you in advance.


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## AlanPechacek (Nov 2, 2017)

This one is tricky because of the semantics involved.  Your surgeon did two things: 1: excised a degenerative or mucous cyst from the capsule of the DIP Joint (26160), and 2: an arthrotomy of the same joint and removed an osteophyte from the distal phalanx (26236).  In doing so, the 26080 is excluded because he did more than just an arthrotomy.  The osteophyte of the distal phalanx is neither a bone cyst nor a benign tumor of the phalanx, so 26210 does not apply.  You are left with 26160 and 26236 plus a Modifier, probably 51 for Multiple Procedures.

I hope this helps.

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


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## MI_CODER (Nov 2, 2017)

This helps me out a lot. Thank you for taking the time to respond to my question. I really appreciate it.


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## fish4codes (Mar 15, 2018)

Dr. Pechacek - question - coding for hand surgeons, this is a routine procedure (excision of ganglion, opening the joint and osteophyte removal with rongeur) and I do apply the 26235/36 understanding that the ganglion, etc. is inclusive/bundles.   However, it has come to my attention I may be missing something!  My question is, should I also be coding the arthrotomy, 26080, as it does not bundle/edits.   Thank you for your time and input!


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