Orthopedic Coding Alert

Most orthopedic surgery coders are familiar with the 26XXX series of CPT Codes for hand surgery. But unlike many surgery chapters for other specialties, there is an intimidating abundance of hand surgery codes. Questions frequently arise as to the slight but important distinctions between the different types of hand surgery procedures and the accompanying codes. Our coding primer examines some of the complexities of hand surgery coding. Because of the breadth of the subject, this primer will be presented in a two-part series, the first dealing with soft tissue surgeries of the hand. The second part of the series, involving surgery of the bones of the hand, will appear in the July 2000 issue of Orthopedic Coding Alert.

Definitions of Common Hand Surgeries

Dr. James Guerra, MD, VACS, of Collier Sports Medicine and Orthopedic Center in Naples, Fla., identifies the most common orthopedic surgeries of the hand.

Incision Surgeries

Fasciotomy: Incision through a fascia; used in the treatment of certain vascular disorders and injuries when marked swelling is anticipated that could compromise blood flow; may be combined with embolectomy in the treatment of acute arterial embolism. In hand surgery, says Guerra, fasciotomy is often used to treat a compartment syndrome of the hand, which may occur due to a crush injury.

Decompressive fasciotomy (hand): The removal of swelling or pressure in the hand through the use of an incision in the fascia of the hand.
Codes
26037 (decompression fasciotomy, hand)
26040 (fasciotomy, palmar [e.g., Dupuytrens contracture]; percutaneous)
(Often used for the treatment of Dupuytrens contracture; a disease of the palmar fascia resulting in thickening and shortening of fibrous bands on the palmar surface of the hands and fingers.)
26045 (fasciotomy, palmar; open, partial)

Tenotomy: The surgical division of a tendon for the relief of a deformity caused by congenital or acquired shortening of the muscle. Guerra explains that in hand surgery, tenotomy is commonly used to treat spastic hand disorders in which a tendon contracture occurs.
Code
26060 (tenotomy, percutaneous, single, each digit)
For multiple digits during the same surgery, repeat the code using a -59 modifier for distinct procedural service.

Arthrotomy: The cutting into a joint. For hand surgery, arthrotomy is used to explore a joint for a foreign body or debride a joint for an infection.
Codes
26070 (arthrotomy, with exploration, drainage, or removal of loose or foreign body; carpometacarpal joint)
26075 (arthrotomy, with exploration, drainage, or removal of loose or foreign body; metacarpophalangeal joint, each)
26080 (arthrotomy, with exploration, drainage, or removal of loose or foreign body; interphalangeal joint, each)

For codes 26075 and 26080, when operating on multiple joints at the same time and at the same site of incision, code each joint separately and use modifier -51 for multiple procedures on the subsequent joints.

Guerra pointed [...]