Orthopedic Coding Alert

Know extensor/flexor differences or face miscoding.

When a patient reports to your surgeon for repair of tendons or muscles in their forearm/wrist, coding can turn confusing fast if you’re not sure what to look for.

Such as? Knowing the types of imaging and other presurgical services the orthopedist might use is essential, as is knowing exactly which muscle in the forearm/wrist they treated.

Confused? Don’t be; check out these tips on coding wrist and forearm repairs right the first time.

Check for These Presurgical Services

Before a forearm/wrist repair happens, the provider will likely perform an evaluation and management (E/M) service. The physician will likely perform an office/outpatient E/M, which you’d code with 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.) Be observant, though; the physician might perform another E/M service — such as hospital inpatient or observation — before deciding on the procedure.

There are also several imaging services the provider might order to confirm the need for surgery. These could be X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI). Here’s a look at the codes you’d use for these imaging studies:

X-ray

• 73090 (Radiologic examination; forearm, 2 views)
• 73100 (Radiologic examination, wrist; 2 views)
• 73110 (… complete, minimum of 3 views)
• 73115 (Radiologic examination, wrist, arthrography, radiological supervision and interpretation)

CT scan

• 73206 (Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing)
• MRI
• 73218 (Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)) through 73220 (… without contrast material(s), followed by contrast material(s) and further sequences)
• 73221 (Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)) thru 73223 (… without contrast material(s), followed by contrast material(s) and further sequences)

Separate Flexor, Extensor Repair Codes

When your surgeon decides on a surgical solution to your patient’s wrist/forearm woes, you’ll be able to move onto the procedure codes.

It’s important to note that these wrist/forearm repairs are broken into two categories: repair of flexor tendons/muscles and repair of extensor tendons/muscles.

The difference? Extensor muscles help in straightening or extending whereas flexor muscles help in bending our elbows, knees and fingers.

Do This for Flexor Repairs

There are a pair of repair types that the orthopedist can make for a patient with flexor issues in their forearm/wrist. In the first, called a primary repair, the surgeon repairs a flexor tendon or muscle in the forearm or wrist. They perform this repair soon after a traumatic injury.

The second type of repair is called, appropriately enough, secondary. During this repair, the surgeon performs the repair after the passage of time from the original traumatic injury. The surgeon repairs a flexor tendon or muscle in the forearm or wrist. During the procedure, the surgeon might opt to apply a tissue graft obtained from another location in the patient’s body.

When your surgeon performs flexor forearm/wrist repair, choose from the following codes, depending on encounter specifics:

• 25260 (Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle)
• 25263 (… secondary, single, each tendon or muscle)
• 25265 (… secondary, with free graft (includes obtaining graft), each tendon or muscle))

Do This for Extensor Repairs

The orthopedist might also perform primary or secondary repair on patients with extensor issues in their forearm/ wrist.

For extensor forearm/wrist repairs, you’ll choose from the following codes:

• 25270 (Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle)
• 25272 (… secondary, single, each tendon or muscle)
• 25275 (… secondary, with free graft (includes obtaining graft), each tendon or muscle)