Orthopedic Coding Alert

Hint: Injections and incisions guide your reporting.

You can take the tension out of your hand tendinitis reporting if you can identify specific codes for injections and surgical approach. All you need to confirm is the extent of the tenosynovitis in De Quervain’s Syndrome and injection site in the wrist.

What is De Quervain’s syndrome? De Quervain’s tenosynovitis is an irritation of the tendons on the thumb side (radial) side of the wrist. Specifically, De Quervain’s tenosynovitis is tenosynovitis of the first dorsal compartment of the wrist which comprises the tendons of the abductor pollicus longus and extensor pollicis brevis,” says Ruby O’Brochta-Woodward, BSN, CPC, CCS-P, COSC, ACS-OR, compliance and research specialist, Twin Cities Orthopedics, P.A. This may cause painful thumb movements. This condition is also referred to as the radial styloid tenosynovitis.

There may be several treatment options that your surgeon may use. “Treatment for De Quervain’s Syndrome often begins with anti-inflammatory use, potential steroid injections into the first extensor sheath, rest and/or strapping or splinting,” says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Auditing and Coding, senior orthopedic coder & auditor, The Coding Network, Washington. “Thumb spica casts may also be used for treatment and are often applied for up to a month.  A combination of injection and casting may also be used.  Should medical treatment with drugs, casting or injection not be successful, surgical release of the first compartment (De Quervain’s release) may be indicated.”

Check for Injections in the Wrist

Your surgeon may treat De Quervain’s tendinitis with injections into the wrist compartment. You report this with code 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar “fascia”]). “The injection is into the tendon sheath, and for this you report code 20550,” says Stumpf. An alternative for you to turn to may be 20551 (Injection[s]; single tendon origin/insertion).

Site drives your code choice: To get to the right code, you may choose 20550 over 20551 as an injection given around the tendon sheath is best reported with 20550. “A tendon origin injection is not the intent of the injection, nor is a small joint injection the target,” says Stumpf. “De Quervain’s tendinitis affects the sheath of the tendons in the first dorsal compartment and documentation should clearly describe the location of the injection for proper code assignment and support.”

Report the Surgical Procedure

In a patient who fails to respond to conservative methods and injections, your surgeon may decide to surgically incise the tendon sheath to relieve the pressure in the wrist. For this surgical incision, you would look to code 25000 (Incision, extensor tendon sheath, wrist [e.g., De Quervains disease]). If your surgeon does a more radical tenosynovectomy of the first dorsal compartment, you may turn to code 25118 (Synovectomy, extensor tendon sheath, wrist, single compartment). “When extensive or prolific tenosynovitis is present, your surgeon may do a radical tenosynovectomy of the first dorsal compartment. Make sure that you keep documentation for an extensive tenosynovectomy.”