# Wrist Tenosynovectomy Extensors AND Flexors



## Ccgerson (Jun 28, 2016)

The physician did both extensors and flexors, also carpal tunnel release.  I believe the correct CPT codes are 25115 and 25116.  The CTR is included in both codes.  
There is an edit with these - 25115 is included in 25116.  However, the physician did 2 incisions.  Here is the OP note:

First, I addressed the flexor tenosynovitis. An extended carpal tunnel incision was made from the palm, crossing the wrist in a zigzag fashion, then longitudinally up the forearm, with a 15 blade. The subcutaneous tissue was dissected with Littler scissors. Hemostasis was maintained with bipolar electrocautery. The palmar fascia was incised longitudinally. The distal aspect of the transverse carpal ligament was identified. A hemostat was placed below the ligament to protect the underlying nerve. The transverse carpal ligament was divided with a 15 blade. The forearm fascia was also opened with a 15 blade. The median nerve was inspected and had an hourglass appearance in the region of the carpal tunnel. There is also thickly adherent tenosynovium about the median nerve and the surrounding flexor tendons. Care was taken to protect the median nerve through the remainder of the procedure. Dissection was carried into the tenosynovium, where frank pus was encountered. Multiple cultures swabs as well as a tissue culture was taken from the flexor tendon and the tenosynovium in the carpal tunnel. The tenosynovium was excised systematically from around each of the flexor tendons sequentially using the Metzenbaum scissors. The flexors in the carpal tunnel were then irrigated with 3 L of saline by cystoscopy tubing. A medium Hemovac was then holes was placed at the base of the carpal tunnel, and brought through the skin in line with the incision proximally in the forearm. The skin was loosely closed with 3-0 nylon.


Attention was turned to the extensor tenosynovitis. A longitudinal incision centered over Lister's tubercle was made with a 15 blade. The tissues dissected with Littler scissors. There was significant clear yellow edematous fluid in the subcutaneous tissues on the dorsal hand. Hemostasis was maintained with bipolar electrocautery. Full-thickness flaps were elevated medial laterally. The subcutaneous tissue was normally adherent to the fascial layer. The third extensor compartment was identified and opened using a Metzenbaum scissors. There was frank pus within the third extensor compartment. Cultures also taken of the EPL compartment. The EPL was transposed out of the compartment. The fourth extensor compartment retinaculum was opened with the a step cut using the 15 blade. There was significant tenosynovium enveloping the extensor tendons. There was frank pus in the fourth extensor compartment as well. More tissue swabs were taken. A tissue culture was taken from the extensor tenosynovium as well. The tenosynovium was then excised systematically from each of the extensor tendons sequentially. The extensors were then irrigated with 3 L of sterile saline by cystoscopy tubing. The fourth compartment extensor retinaculum was then closed in a Z lengthened position with 2-0 PDS. The EPL was left out. A medium Hemovac with 10 holes was placed at the floor of the fourth compartment and exited proximally in line with the incision dorsally in the forearm. A Penrose drain was left exiting the distal aspect of the dorsal wound. The skin was then closed loosely with 3-0 nylon.


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## Orthocoderpgu (Jun 30, 2016)

25515 & 25516 don't hit an edit. I can see the need for two separate incisions. A volar incision would be made for the flexor tendons and a dorsal incision for the extensor tendons. They do hit an edit with 64721 though.


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## Ccgerson (Jul 1, 2016)

*Edits*

Where do you look to find edits?  I was taught to look in Code-X under the code, then look under the "includes" tab to see if another code is included.  Additionally, I tested it in EPIC, our billing software.  I put both codes in, and was received this error  "CCI edit failed for CPT(R) codes 25116 and 25115: Standards of medical / surgical practice."
I've only been coding for 7 months, so still learning. 
Thanks


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## shecodes (Jul 5, 2016)

Your coding looks correct to me Ccgerson. 

25115 (includes the carpal tunnel) is considered inclusive to 25116 per NCCI edits, however the separate incision supports the usage of modifier 59.


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