Wiki Extensor Tenosynovectomy

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wmcodylee

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What code is everyone using for extensor tenosynovectomy of the hand/fingers. 26145 will not work because that is for flexors.

The Dr. says Extensor tenosynovectomies were performed on the EDC of the index, long, ring, and small; EDQ small; EIP index.

I cant find a code for extensor tenosynovectomy of the hand.
 
For what it is worth, the extensor tendons to the fingers enter the hand from the dorsal forearm, cross the dorsal wrist, then proceed over the hand/metacarpals to the fingers. The Extensor Digitorum Communis (EDC) tendons and Extensor Indicis Proprius (EIP) cross the dorsal wrist together through a single/common "compartment." The Extensor Digiti Quinti (EDQ) to the small finger may have its own "compartment," but not necessarily always and may enter with the other extensors. When an Extensor Tenosynovectomy is done, it is usually done at the dorsal wrist level then extended distally into the dorsal hand or proximally into the dorsal forearm as necessary, and rarely all the way out to and including the finger(s). The other thing to take into consideration is the underlying diagnosis as this affects the coding. If there is chronic florid hypertrophic tenosynovitis such as Rheumatoid Arthritis or chronic infectious tenosynovitis, the 25116 for "Radical" Extensor Tenosynovectomy would apply, particularly if multiple extensor compartments were opened/treated. For less severe tenosynovitis and when only one compartment is opened/treated, then 25118 would apply. For the case mentioned in this query, I think 25118 would be most correct.

I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.
 
Appreciate your answer, Dr. Pechacek!

AlanPechacek said:
For what it is worth, the extensor tendons to the fingers enter the hand from the dorsal forearm, cross the dorsal wrist, then proceed over the hand/metacarpals to the fingers. The Extensor Digitorum Communis (EDC) tendons and Extensor Indicis Proprius (EIP) cross the dorsal wrist together through a single/common "compartment." The Extensor Digiti Quinti (EDQ) to the small finger may have its own "compartment," but not necessarily always and may enter with the other extensors. When an Extensor Tenosynovectomy is done, it is usually done at the dorsal wrist level then extended distally into the dorsal hand or proximally into the dorsal forearm as necessary, and rarely all the way out to and including the finger(s). The other thing to take into consideration is the underlying diagnosis as this affects the coding. If there is chronic florid hypertrophic tenosynovitis such as Rheumatoid Arthritis or chronic infectious tenosynovitis, the 25116 for "Radical" Extensor Tenosynovectomy would apply, particularly if multiple extensor compartments were opened/treated. For less severe tenosynovitis and when only one compartment is opened/treated, then 25118 would apply. For the case mentioned in this query, I think 25118 would be most correct.

I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.
Click to expand...

Although I didn't write the initial question, your answer is just what I needed for one I'm tackling today.

Patti White, CPC
 
Would you be able to offer any advise as to what the correct coding would be for a right fourth extensor compartment tenosynovectomy and a long finger extensor tendon cyst excision with longitudinal tendon repair completed through the same incision?

I am thinking the tendon repair is inclusive to the cyst excision (pathology came back as soft tissue intra tendonous mass).
Would it be appropriate to code CPT 25118 AND 26116 together as the physician has them listed as separate procedures? I am thinking the right long finger dorsal boss excision would be bundled?

POSTOPERATIVE DIAGNOSIS: Right fourth extensor compartment tenosynovectomy with possible cyst.
OPERATIONS PERFORMED: 1. Right long finger extensor tendon cyst excision with longitudinal tendon repair.2. Right fourth extensor compartment tenosynovectomy.3. Excision of right long finger dorsal boss excision.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and placed in the supine position on the operating room table. General anesthesia was administered without complication. The right upper extremity was prepped and draped in the usual sterile manner. The tourniquet was inflated to 250 mmHg pressure. A longitudinal incision was made over the right dorsal wrist. Dissection was carried down through the skin and subcutaneous tissues. The fourth extensor compartment was visualized. It had a lot of inflamed tenosynovitis. I excised all this inflamed tenosynovitis. When I got to the right long finger extensor tendon, there was a ganglion cyst within the tendon itself. I had to split the tendon and then debride the tendon sheath using a curette. This removed the cyst fairly nicely. I did wash it out and then repaired the tendon longitudinally with a running 5-0 Prolene suture. There was a prominent CMC boss coming off the long finger metacarpal. This was excised, and the bone was smoothed down. The soft tissues were closed with Monocryl. I did do a pretty extensive tenosynovectomy of the fourth extensor compartment. The wound was washed out vigorously. The skin was closed with 4-0 Monocryl sutures, followed by Benzoin, Steri-Strips, 4x4s, Sof-Rol, and a well-padded volar splint.

Thank you.
 
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