Wiki Coding for open TFCC

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Slizs1283

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The doctor I code for frequently completes an Open treatment of ulnar styloid fracture. I know to code 25652 for open treatment of the ulnar, however he always adds an open repair of the triangular fibrocartilage complex using suture anchor technique. Here is an example from one OP note.

We noted the styloid fragment to be quite fragmented and not amendable to fixation either with pins or with screws: therefore, the fragmented ulnar styloid fracture fragment was removed with sharp dissection, we placed a 3.5 smith and nephew suture anchor and used the attached 0 ultrabrad suture to repair the triangular fibrocartilage complete to the suture anchor in the ulnar sulcus. Flouroscopy again confirmed position alighnment of the implant within the area of the ulnar. Now, we repaired the capsule of the distal radioulnar joint with the ultrabraid suture and repaired the ECU tendon sheath with 0 ultrabraid suture.

Would you code 25652 and 25107 for the open TFCC repair and ORIF of ulnar styloid fracture or just 25652 for open treatment of the ulnar styloid fracture?
 
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Slizs1283 said:
The doctor I code for frequently completes an Open treatment of ulnar styloid fracture. I know to code 25652 for open treatment of the ulnar, however he always adds an open repair of the triangular fibrocartilage complex using suture anchor technique. Here is an example from one OP note.

We noted the styloid fragment to be quite fragmented and not amendable to fixation either with pins or with screws: therefore, the fragmented ulnar styloid fracture fragment was removed with sharp dissection, we placed a 3.5 smith and nephew suture anchor and used the attached 0 ultrabrad suture to repair the triangular fibrocartilage complete to the suture anchor in the ulnar sulcus. Flouroscopy again confirmed position alighnment of the implant within the area of the ulnar. Now, we repaired the capsule of the distal radioulnar joint with the ultrabraid suture and repaired the ECU tendon sheath with 0 ultrabraid suture.

Would you code 25652 and 25107 for the open TFCC repair and ORIF of ulnar styloid fracture or just 25652 for open treatment of the ulnar styloid fracture?
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What anatomical structure attaches to the ulnar styloid?
 
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Slizs1283 said:
Ok, so you would code for both 25107 and 25652? I just want to make sure I am not overbilling when I code the procedure. I appreciate the help.
Click to expand...
Was the TFCC repaired? or just re-attached? The TFCC ligament attaches to the ulnar styloid which can usually be repaired with pins when it breaks. However in this case the fracture was too fragmented for that. So the styloid process was removed. This leaves the TFCC ligament without an attachment point. After removing the styloid process the provider had to re-attach the TFCC ligament to the ulna. So no, the TFCC was not repaired, it was re-attached, in this case.
 
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