Orthopedic Coding Alert

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).

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). 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.