Wiki Coding for Closed Capsulotomy of PIP Joint

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Kevinph84

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Hello Everyone,

I had a question on coding a CLOSED capsulotomy on the PIP joint of a finger. All the provider stated was a CLOSED capsulotomy was performed. It was due to a joint contracture developing postoperatively due to scarring from a PIP joint replacement for severe osteoarthritis.

Looking up through the CPT index, capsulotomy directs you to use CPT 26525 (Capsulectomy or capsulotomy; interphalangeal joint, each joint ). However! After reading the lay description, it seems the code is strictly for an incsional approach. Please see the below lay description.

....The physician removes or incises the joint capsule to release contracture and restore function. The physician incises the overlying the skin and dissects to the metacarpophalangeal joint. The capsule of the joint is incised or resected and removed. The incision is sutured in layers. In 26520, the capsulectomy or capsulotomy is performed on the metacarpophalangeal joint. In 26525 the capsulectomy or capsulotomy is performed on the interphalangeal joint. Report each joint separately.

My question is it appropriate to report 26525 for a closed capsulotomy? Is there another code that better fits this situation? Thank you for all your time and help.

Respectfully Yours,

Kevin P Honig, CPC

P.S. Happy Holidays!!
 
My question is did you check with the provider to be sure they did a closed procedure, otherwise how did he perform a capsulotomy as a closed procedure.
 
Hello,

I am in the midst of querying him for clarification on the closed capsulotomy. When I first read the report, I also couldn't see how a closed capsulotomy could be performed. I will let you know when I get his answer. Thank you.
 
A closed capsulotomy could be done with a technique called microcapsulotomy. It is done percutaneously with a needle to break up scar tissue in the capsule and to restore mobility (in addition to joint manipulation under anesthesial). Some coding options that come to mind are 1) open capsulotomy code with modifier 52, or 2) manipulation under anesthesia with modifier 22, or 3) unlisted code compared to a percutaneous tenotomy.
 
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