Orthopedic Coding Alert

" Know your anatomy to differentiate tendon codes from nerve codes

Hand and wrist surgery operative reports can be overwhelming, particularly when the surgeon performs more than 10 procedures. Our experts have the key to keeping your claims in order: Break down the services by site.

Read the following operative note and determine how you would code the service. Summarize the Op Report The patient had the following injuries:

- A 12-cm complex laceration to the volar right wrist.

- Transections of the radial artery, superficial radial nerve, abductor pollicis longus, brachioradialis tendon, middle finger flexor digitorum superficialis, and palmaris longus.

- Partial transections of the extensor pollicis brevis, ring finger flexor digitorum superficialis and flexor pollicis longus tendons. Procedure: The surgeon irrigated and debrided full-thickness skin edges, subcutaneous tissue, muscle and tendon of the left forearm laceration and performed a complex repair of the 12-cm laceration to the forearm. He repaired the radial artery with a reversed vein graft, which he harvested from the volar forearm. Next, he  repaired the superficial radial nerve after neurolysis using Neurogen conduit.

The orthopedic surgeon then repaired the extensor pollicis brevis (EPB), the abductor pollicis longus (APL), the brachioradialis (BR), the ring finger flexor digitorum superficialis (FDS4), the middle finger flexor digitorum superficialis (FDS3), the palmaris longus (PL), and the flexor pollicis longus (FPL) tendon.

Code the procedure: -Reporting a procedure like this requires a vast knowledge of anatomy,- says Jay Neal, an independent coding and billing consultant in Atlanta. -If you don't know whether the pollicis brevis is a tendon, a muscle or a nerve, you won't know which code to report. The same goes for all of the other terms in the surgeon's report.-

Check out the following coding advice from Annette Grady, CPC, CPC-H, healthcare consultant in Bismarck, N.D., and member of the AAPC National Advisory Board.

Step 1: Report the artery repair. Typically, you should list the highest-valued procedure first, coding experts say. In this case, the arterial repair code 35236 (Repair blood vessel with vein graft; upper extremity) rates the highest dollar value with 27.36 RVUs in 2006.

You should link 35236 to ICD-9 code 903.2 (Injury to blood vessels of upper extremity; radial blood vessels).

According to the American Society of Surgery for the Hand's (ASSH) Global Service Guide for Hand Surgery, harvesting and/or insertion of a vein graft is included in the reimbursement for 35236, so you should not report any additional codes for the vein harvesting.

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