Orthopedic Coding Alert

Question: I performed a finger examination and manipulation under anesthesia for a mentally retarded patient. The patient had finger stiffness and pain following a prior open reduction to repair a fractured finger. Which codes should I report?

Ohio Subscriber Answer: You should report 26340 (Manipulation, finger joint, under anesthesia, each joint) for the procedure. In this case, however, it's the diagnosis coding that might throw you for a loop. Your patient has an underlying condition (the mental retardation), along with late effects of a fracture.
 
You should first report the symptoms that precipitated the procedure, such as stiffness (719.54), pain (719.44), or other problems.
 
Next, report 905.2 (Late effect of fracture of upper extremities) to indicate that the symptoms were caused by a prior fracture.
 
Finally, you should report the appropriate code for mental retardation (317-319). This tells the insurer that the patient has an underlying condition. It might also help the insurer understand why you performed the surgery in the operating room under anesthesia rather than simply manipulating the finger in your office.