Orthopedic Coding Alert

Question: What code do we use for a MCP capsulorrhaphy? The operative note reads:

"At this point the patient then had the laceration extended both proximally and distally and this allowed exposure of the extensor tendon. This was noted to be lacerated just past the extensor hood from the lateral bands. This was then evaluated, and the tendon substance was still felt to be viable. There was felt to be disruption of the long finger MCP capsule. At this point this was then irrigated and the capsule then was closed using a 4-0 Vicryl in a figure-of-eight fashion. The patient then had the extensor tendon repaired using a bunnel stitch and this was then repaired down (26418). This was noted to have good apposition of the tendon ends as there was no gapping on Speed's test. Patient then had the wound irrigated. The skin was then closed using 3-0 Nylon in a horizontal, mattress fashion and sterile dressing was then applied. The patient's hand was then placed in a dorsal blocking splint intrinsic plus position which he tolerated well."

Oklahoma Subscriber

Answer: You report code 26437 (Realignment of extensor tendon, hand, each tendon) for the realignment of the extensor tendon. Code 26418 (Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon) is for the repair of the extensor tendons. There isn't an additional code for the repair of the MCP joint because it can only be lacerated if the extensor tendon is lacerated, too, and the repair of the extensor tendon is inclusive of both.