Wiki Help with Billing 26445 and 26520 to Worker's Comp

[Mjohnstone]

I billed 26445 and 26520-59 to a Worker's Comp company and they denied the 26520-59 as inclusive per April 2002 CPT Assistant. This seems to be a bit out of date to create a denial. Here are the surgical notes:
DX : S62.321S
Description of Procedure:

The patient was greeted in the preoperative hold area on the morning of 5/22/2020. Left hand was confirmed the proper procedural site and marked. All questions were answered and the consent was reviewed. Patient was then taken back to the operating room where surgical timeout was had. He was given some IV sedation. Bier block was placed by anesthesia.

The left arm was prepped and draped. After prepping and draping, we re-accessed the patient’s dorsal tissues below. These were gently released with dissecting scissors. There was also found to be some scarring between the extensor tendon and the metacarpal shaft. This was gently released both with scissor dissection and a Freer elevator. Freer elevator was moved distally between the skin and tendon and joint capsule of the MP joint and then also placed beneath the tendon and joint capsule and worked distally as well.

This improved mobility, but there was still some capsular tightness, so 15 blade was used to the radial aspect of the joint capsule, thus breaking up more scar bands. The radial sagittal band was not violated. We then gently continue to passively flex the MP joint of the index finger. We could see the pristine metacarpal head as the capsule began to stretch and divide. And are able to passively flex the MP joint down to about 95 to 100 degrees of flexion. PIP joint flexed to about 115 degrees.

Thank you for any guidance.

 

[Orthocoderpgu]

These two codes don't hit an edit so I'm not sure why it was billed with a -59. Code 26520 has more RVU than 26445 so 26445 would have had the -59 if it was needed. The fracture itself is not being treated, the patient is just having limited movement due to scar tissue and adhesions. Both the capsulotomy and the tenolysis was performed for the same purpose, to increase movement. So you can't say that these were two separate procedures performed for separate and or unrelated reasons. The information given in the CPT Assistant may be a bit dated, but the human anatomy and the surgical procedures have not changed in the past 18 years either. For these two reasons I think it would be very difficult to get this paid at this point.

 

[Mjohnstone]

These two codes don't hit an edit so I'm not sure why it was billed with a -59. Code 26520 has more RVU than 26445 so 26445 would have had the -59 if it was needed. The fracture itself is not being treated, the patient is just having limited movement due to scar tissue and adhesions. Both the capsulotomy and the tenolysis was performed for the same purpose, to increase movement. So you can't say that these were two separate procedures performed for separate and or unrelated reasons. The information given in the CPT Assistant may be a bit dated, but the human anatomy and the surgical procedures have not changed in the past 18 years either. For these two reasons I think it would be very difficult to get this paid at this point.

Thank you for your help.