Orthopedic Coding Alert

Question: The surgeon removed external fixation from the left distal radius and ulna; performed manipulation of the left wrist; completed manipulation to digits 1-5 to increase IP joint motion to the left palm; and manipulated the DIP, PIP, and MCP joints to gain range of motion. How should I code all these individual manipulations?

Tennessee Subscriber

Answer: Your primary code is 20694 (Removal, under anesthesia, of external fixation system); the wrist manipulation is bundled with the removal of external fixation for that anatomic site, so you won't separately report that. Finger joint manipulations also are bundled with 20694, but you can code them in this instance because they are separate sites from the wrist. Report 26340 (Manipulation, finger joint, under anesthesia, each joint) with the appropriate digit modifiers from F1-F9. Also append modifier 59 (Distinct procedural service) to each finger manipulation.

Carrier watch: The code descriptor states "each joint," so you can report 26340 for multiple joints of a single digit your physician manipulates. Whether you'll be paid for each manipulation depends on your carrier. Some payers also might deny your claim if you submit finger joint manipulations as units instead of individual line items. Check your local guidelines before filing.