# Extensor Tenosynovectomy



## wmcodylee (Jan 9, 2018)

What code is everyone using for extensor tenosynovectomy of the hand/fingers. 26145 will not work because that is for flexors. 

The Dr. says Extensor tenosynovectomies were performed on the EDC of the index, long, ring, and small; EDQ small; EIP index.

I cant find a code for extensor tenosynovectomy of the hand.


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## stephpatschorke (Jan 9, 2018)

How about 25118?


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## fish4codes (Jan 10, 2018)

I would use 25118 (it has a MUE of 5)


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## AlanPechacek (Jan 10, 2018)

For what it is worth, the extensor tendons to the fingers enter the hand from the dorsal forearm, cross the dorsal wrist, then proceed over the hand/metacarpals to the fingers.  The *Extensor Digitorum Communis (EDC)* tendons and *Extensor Indicis Proprius (EIP)* cross the dorsal wrist together through a single/common "compartment."  The *Extensor Digiti Quinti (EDQ)* to the small finger may have its own "compartment," but not necessarily always and may enter with the other extensors.  When an *Extensor* *Tenosynovectomy* is done, it is usually done at the dorsal wrist level then extended distally into the dorsal hand or proximally into the dorsal forearm as necessary, and rarely all the way out to and including the finger(s).  The other thing to take into consideration is the underlying diagnosis as this affects the coding.  If there is chronic florid hypertrophic tenosynovitis such as Rheumatoid Arthritis or chronic infectious tenosynovitis, the *25116* for *"Radical" Extensor Tenosynovectomy* would apply, particularly if multiple extensor compartments were opened/treated.   For less severe tenosynovitis and when only one compartment is opened/treated, then *25118* would apply.   For the case mentioned in this query, I think 25118 would be most correct.

I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.


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## PattiW (Nov 21, 2018)

*Appreciate your answer, Dr. Pechacek!*



AlanPechacek said:


> For what it is worth, the extensor tendons to the fingers enter the hand from the dorsal forearm, cross the dorsal wrist, then proceed over the hand/metacarpals to the fingers.  The *Extensor Digitorum Communis (EDC)* tendons and *Extensor Indicis Proprius (EIP)* cross the dorsal wrist together through a single/common "compartment."  The *Extensor Digiti Quinti (EDQ)* to the small finger may have its own "compartment," but not necessarily always and may enter with the other extensors.  When an *Extensor* *Tenosynovectomy* is done, it is usually done at the dorsal wrist level then extended distally into the dorsal hand or proximally into the dorsal forearm as necessary, and rarely all the way out to and including the finger(s).  The other thing to take into consideration is the underlying diagnosis as this affects the coding.  If there is chronic florid hypertrophic tenosynovitis such as Rheumatoid Arthritis or chronic infectious tenosynovitis, the *25116* for *"Radical" Extensor Tenosynovectomy* would apply, particularly if multiple extensor compartments were opened/treated.   For less severe tenosynovitis and when only one compartment is opened/treated, then *25118* would apply.   For the case mentioned in this query, I think 25118 would be most correct.
> 
> I hope this helps.
> 
> Respectfully submitted, Alan Pechacek, M.D.



Although I didn't write the initial question, your answer is just what I needed for one I'm tackling today. 

Patti White, CPC


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