Wiki 25118 and 25111

[reichtina320]

Hello!

I am trying to locate information on whether a synovectomy, extensor tendon sheath - 25118 is usually done at the same time as excision of ganlion cyst of the wrist - 25111. I did find that CCI edits state a modifier is allowed; but I can't find in what circumstances.

TIA
Tina

 

[cynthiag14]

Hello, did you ever receive any feedback regarding this scenario? I may have a similar case on hand. "Dorsal approach of the wrist was performed. A large multiloculated ganglion cyst was identified and resected down to the base of the scapholunate ligament. The base of the cyst was cauterized. It appeared benign and had benign features. It was sent to pathology as a specimen. Inflammatory synovitis was identified in the second, third and fourth extensor compartments. Excisional synovectomy of the synovitis was performed with scalpel and Iris scissors, freeing up and excising all the synovitis to help prevent reoccurrence of the ganglion cyst."

 

[amyjph]

No. Look up the meaning of "more extensive procedure" in the NCCI manual. From what you quote above the intent of the procedure was treatment of the ganglion (25111). Even though the 25118 is the primary in the NCCI relationship, I would still report 25111 from what you snipped there.

https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-1.pdf