CODING CORNER: Know Your Anatomy for Top-Notch Hand-Procedure Coding

Take stock of these tips on coding common ligament injuries

Reporting hand surgeries correctly can be tricky because the language describing patients’ injuries isn’t always self-explanatory--and physicians don’t often explain the gritty details, such as the precise location of the injury. Take a look at this refresher course to bone up on your hand surgery lingo and clinical pathology, and you’ll be translating op notes in a snap.
Know Common Ligament Injuries
Repetitive stress and sports often cause ligament injuries, such as TFCC and gamekeeper’s thumb, that require surgical treatment of the hand. During these procedures, the physician pins the bone and repairs the ligament, says Beth Janeway, CPC, CCS-P, CCP, president of Carolina Healthcare Consultants in Winston-Salem, N.C.
Triangular fiber cartilage complex (TFCC is what you’ll probably see on an operative note), for example, is a common sports injury caused by the patient landing on his outstretched arm or repetitive heavy lifting with the ulnar side of the wrist. Physicians typically repair these injuries with arthroscopy, which you’ll report with 29846 (Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridement), Janeway says.
Gamekeeper’s thumb affects the joint where the thumb and palm meet on the ulnar side of the thumb. If an outside force, such as repetitive stress, pushes the thumb sideways away from the index finger, the ligament may tear (and sometimes pieces of bone chip off as well).
When a ligament tears completely, it won’t heal itself--the physician has to remove the tendon and reunite the parts of the ligament. The surgery usually requires a small metal anchor harpooned into the bone to hold the joint in place. You should describe the procedure with 26540 (Repair of collateral ligament, metacarpophalangeal or interphalangeal joint). Remember that you’ll also need to report diagnosis code 842.12 (Sprains and strains of wrist and hand; hand; metacarpophalangeal [joint]).
Find Anatomic Site for Tendinopathy Code
Regardless of whether heredity or an injury causes the tendinopathy, you will need to report the code that best describes the surgery.
In the case of Dupuytren’s contracture, a hereditary thickening of the fascia below the skin of the palm, your code will depend on whether the surgery involved just the palm, the palm and one finger, or the palm and multiple fingers.
If the surgery was only on the patient’s palm, you will report 26121 (Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting [includes obtaining graft]), Janeway says. For surgery on the palm and one finger, you’ll report 26123 (Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local [...]

- Published on 2005-11-21