Orthopedic Coding Alert

Question:  The surgeon did a removal of trapezium, partial resection of trapezoid, and fixation of 1st and 2nd MCP (Thumb and index finger) with a Tightrope™ suture anchor.The operative note follows:

"A T-type of incision was made at the base of the 1st right metacarpal. After dissection of the skin and subcutaneous tissue, the base of the 1st metacarpal was exposed, and the extensor pollicis longus was identified and then transected. About half to an inch of the muscle was resected and the proximal end was let to fly free. The pin guide after that was used for placement of the tightrope from the radial side of the 1st metacarpal to the 2nd metacarpal under the C-arm magnification. After good placement of the guidewire was achieved, the 2.0 size drill was used to make the hole over the guidewire, and a special designed rubber hard tube was placed through over the guidewire. 　The guidewire was then completely removed, and the tightrope was brought from the ulnar side to the radial side. The tightrope was provisionally tightened and good position was achieved at that point."

How do we report the fixation of 1st and 2nd MCP with short tightrope? Can we report code 25210 (Carpectomy; 1 bone) for this situation?

Texas Subscriber

Answer: This is a fairly new procedure being performed in lieu of CMC trapeziectomy with ligament reconstruction and tendon interpositon (LRTI) arthroplasty. In this procedure, the surgeon resects the trapezium, and rather than harvesting a tendon for interposition and ligament reconstruction, he suspends the metacarpal using a tightrope device. Some use the terms "osteodesis" and "suture button suspensionplasty" for this aspect of the procedure. You would report 25210 (Carpectomy; 1 bone) for the trapeziectomy and unlisted code 26989 (Unlisted procedure, hands or fingers) for the tightrope suspension.