Question: Our surgeon recently excised an extensive giant cell tumor of the tendon sheath from a long finger surrounding the PIP joint, and repaired the extensor tendon, which the tumor had damaged. Which codes should I use for these? Nashville Subscriber Answer: Code the tumor excision with 26116 (Excision, tumor or vascular malformation, soft tissue of hand or finger; deep [subfascial or intramuscular]) and the tendon repair with 26418 (Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon). You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J.
Because you referred to the tumor excision as "extensive," you should consider appending modifier -22 (Unusual procedural services) to 26116 if the surgery went above and beyond a normal tumor excision. If you use modifier -22, submit a paper claim with the operative report and a letter explaining the unusual circumstances. Set your fee based on the additional level of difficulty involved in removing the giant cell tumor of the tendon sheath (727.02).