Wiki Finger contracture manipulation

Create Wiki
kimmcelderry@gmail.com

kimmcelderry@gmail.com

Networker
Messages
43
Location
Mobile, AL
Best answers
0
My provider manipulated a patient's finger PIP and DIP joints with just a digital block in-office. Would this be billed as unlisted or is it not billable? Thank you.

"PREOPERATIVE DIAGNOSIS: Contracture left ring finger PIP joint post dislocation.
PROCEDURE: Manipulation PIP and DIP joints.
ANESTHESIA: 1% Lidocaine digital block.
After induction of satisfactory anesthesia, the hand was prepped and draped in a sterile fashion. The PIP joint was manipulated almost to full extension and the DIP joint to range of motion to about 70 degrees. Good flexion was maintained."
 
Is it currently dislocated or did that happen a long time ago and now it's contracted? Because I would venture to use closed treatment of dislocation 26770.
Or you could consider 26340-52 and use the 52 since they didn't do "under anesthesia".
Did you check CPT Assistant?
 
No it was dislocated and treated 2 months prior. This is just contracture resulting from that. I have EncoderPro which doesn't give much detail regarding billing.
 
In that case I would probably go with 26340-52 or maybe even just 26340 no mod. I just don't think an unlisted for something done in the office is going to go over too well. You may end up having to just call it an E&M but that would be kind of weird too especially if the sole purpose of the visit was the procedure and it was technically a procedure so I don't think I would do that either. 26340 is what was done.

I also found this but it's not necessarily "official", definitely makes sense though.

Manipulation codes

How should the manipulation of joint codes be applied?

According to the National Correct Coding Initiative (chapter 1) as well as the AAOS GSD, manipulation of a joint is normally performed during the course of another (major) procedure and requires no additional reporting because it is considered inherent. Problems occur, however, when manipulation is performed as the only procedure, such as outlined in the CPT code 26340 (manipulation, finger joint, under anesthesia, each joint). This and other codes were added in 2002. The January 1999 CPT Assistant noted that the phrase ‘with or under anesthesia’ in a code description meant under general anesthesia. But by 2002, this information was outdated and the terms ‘under anesthesia’ or ‘with anesthesia’ are now understood to reflect the appropriate anesthesia for a given patient and/or given situation.

Regarding EnCoder - I think it might depend on the version you are using because certain versions have lots of detail. There are lay descriptions of codes, edits, add-ons like CPT Asst, NCCI edits, and you can enter all the codes in and check for bundling, dx codes, etc. But again, I think it depends on what version you have.

If you are only doing ortho this is a great tool also: https://www.aaos.org/education/about-aaos-products/codex/
 
amyjph said:
In that case I would probably go with 26340-52 or maybe even just 26340 no mod. I just don't think an unlisted for something done in the office is going to go over too well. You may end up having to just call it an E&M but that would be kind of weird too especially if the sole purpose of the visit was the procedure and it was technically a procedure so I don't think I would do that either. 26340 is what was done.

I also found this but it's not necessarily "official", definitely makes sense though.

Manipulation codes

How should the manipulation of joint codes be applied?

According to the National Correct Coding Initiative (chapter 1) as well as the AAOS GSD, manipulation of a joint is normally performed during the course of another (major) procedure and requires no additional reporting because it is considered inherent. Problems occur, however, when manipulation is performed as the only procedure, such as outlined in the CPT code 26340 (manipulation, finger joint, under anesthesia, each joint). This and other codes were added in 2002. The January 1999 CPT Assistant noted that the phrase ‘with or under anesthesia’ in a code description meant under general anesthesia. But by 2002, this information was outdated and the terms ‘under anesthesia’ or ‘with anesthesia’ are now understood to reflect the appropriate anesthesia for a given patient and/or given situation.

Regarding EnCoder - I think it might depend on the version you are using because certain versions have lots of detail. There are lay descriptions of codes, edits, add-ons like CPT Asst, NCCI edits, and you can enter all the codes in and check for bundling, dx codes, etc. But again, I think it depends on what version you have.

If you are only doing ortho this is a great tool also: https://www.aaos.org/education/about-aaos-products/codex/
Click to expand...
Thank you so much! Great info.
 
You must log in or register to reply here.
Top