Orthopedic Coding Alert

Question: The surgeon performed irrigation and debridement for a right hand abscess and completed extensor tenosynovectomy close to the wrist. Documentation recorded a "rather dense collection of phlegmon in scar tissue which appeared to be in a subcutaneous layer overlying the extensor tendon. Loculations were disrupted with examining finger and nodular tissue was debrided and sent to pathology. There was an apparent intense synovitis surrounding the extensor tendons that was sharply debrided."

Florida Subscriber

Answer: Choosing a code for the extensor tenosynovectomy gets tricky because CPT doesn't have a good hand code for this procedure on the dorsum. Check the surgeon's documentation and verify the location, but 25028 (Incision and drainage, forearm and/or wrist; deep abscess or hematoma) and 26445 (Tenolysis, extensor tendon, hand OR finger, each tendon) could apply if you're close enough to the wrist to use a wrist cod

-- Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.