Orthopedic Coding Alert

Question: In a patient with rheumatoid deformity in the right wrist, our surgeon did the following procedures:

1.   Extensor tenosynovectomy of extensor pollicis longus (EPL), second compartment, fourth compartment, right.

2.   Posterior interosseous nerve neurectomy in the distal forearm, right.

3.   Distal ulna resection (Darrach procedure).

4.   Right wrist fusion.

5.   Index proprius transfer to extensor digiti minimi.

Please suggest the best codes we can submit.

Maryland Subscriber

Answer: You report code 25118 (Synovectomy, extensor tendon sheath, wrist, single compartment) for the synovectomy and you can bill this thrice, i.e., once each for the 1^st, 2nd, and 4th compartments (EPL is in the 1st extensor compartment). You can report 64782 (Excision of neuroma; hand or foot, except digital nerve) for the posterior interosseous nerve neurectomy.

For the distal ulna resection, you report 25240 (Excision distal ulna partial or complete [e.g., Darrach type or matched resection]). Note that code 25119 (Synovectomy, extensor tendon sheath, wrist, single compartment; with resection of distal ulna) is for extensor tenosynovectomy with excision distal ulna. Though your surgeon is doing an extensor synovectomy with distal ulna excision, you may still select 25240 over 25119 as your surgeon is not doing the extensor synovectomy in the compartments (5th or 6th extensor compartment) contiguous to the ulna.

For the right wrist fusion, you report code 25800 (Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or intercarpal and/or carpometacarpal joints) or 25810 (Arthrodesis, wrist; with iliac or other autograft [includes obtaining graft]) if autograft is harvested. For the Index proprius transfer to extensor digiti minimi, you report code 25310 (Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon). If however, your surgeon uses another tendon graft, you report 25312 (Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; with tendon graft[s] [includes obtaining graft], each tendon).