kkidd91
Contributor
This code combination has been posted in the past; however, it has been a few years since the most recent thread. I am hoping someone may be able to confirm if my thought process is correct.
The intent for the procedure was a trigger finger release (26055), The physician exposed and excised the tendon sheath, the physician then found a ganglion on the tendon sheath and excised it an passed it off as waste.
My thought is to code 26160 for the ganglion excision only as it has a higher RVU and 26055 is bundled to 26160. I am a little thrown off though as the physician does not list a diagnosis code for the ganglion and it was discarded and not sent to pathology. Would you add diagnosis M67.442 since the physician states ganglion in the description of procedure?
We have a 2022 Optum 360 orthopedic companion that states under CPT 26160 (For a tendon sheath incision, without excision of a ganglion use 26055)
This procedure was completed at an ASC:
POSTOPERATIVE DIAGNOSIS: Left long finger trigger
OPERATIONS PERFORMED: 1. Left long finger trigger release. 2. Excision of ganglion cyst tendon sheath
DESCRIPTION OF PROCEDURE: The patient was met in the holding area. The surgical site was marked and confirmed. Questions were answered. We then proceeded to the OR. Once in the OR, the patient underwent administration of IV sedation. The bed was rotated to allow better access to the left upper extremity. The forearm tourniquet was applied, and the hand table was attached to the left side of the gurney. The patient then underwent infiltration of local anesthetic into the soft tissues overlying the tendon sheath of the left long finger. Once adequate local anesthetic had been obtained, the extremity was prepped and draped. After prep and drape, a timeout was performed. After routine timeout, we proceeded with the procedure. I exsanguinated the extremity with an Esmarch bandage and inflated the tourniquet to 250 mmHg. I then made an oblique incision overlying the tendon sheath of the left long finger starting at the distal palmar crease and then following along the crease. Sharp dissection through the skin was followed by blunt dissection. I exposed the tendon sheath, and under direct visualization, I excised it. There was presence of a ganglion on the tendon sheath of the left long finger. This was excised and passed off as a waste. I completed opening the tendon sheath and then deflated the tourniquet. I irrigated the wound thoroughly with sterile normal saline. I obtained hemostasis with bipolar cautery and pressure. I irrigated the wound thoroughly and then closed the incision using 5-0 nylon. I washed and dried the extremity. I applied dressings of Xeroform, sterile gauze, sterile Kling, and tape. The patient was then awakened and taken to the recovery room. She arrived in the recovery room in stable condition still under the influence of IV sedation. All counts correct x2
Thank you for taking the time to read my post.
The intent for the procedure was a trigger finger release (26055), The physician exposed and excised the tendon sheath, the physician then found a ganglion on the tendon sheath and excised it an passed it off as waste.
My thought is to code 26160 for the ganglion excision only as it has a higher RVU and 26055 is bundled to 26160. I am a little thrown off though as the physician does not list a diagnosis code for the ganglion and it was discarded and not sent to pathology. Would you add diagnosis M67.442 since the physician states ganglion in the description of procedure?
We have a 2022 Optum 360 orthopedic companion that states under CPT 26160 (For a tendon sheath incision, without excision of a ganglion use 26055)
This procedure was completed at an ASC:
POSTOPERATIVE DIAGNOSIS: Left long finger trigger
OPERATIONS PERFORMED: 1. Left long finger trigger release. 2. Excision of ganglion cyst tendon sheath
DESCRIPTION OF PROCEDURE: The patient was met in the holding area. The surgical site was marked and confirmed. Questions were answered. We then proceeded to the OR. Once in the OR, the patient underwent administration of IV sedation. The bed was rotated to allow better access to the left upper extremity. The forearm tourniquet was applied, and the hand table was attached to the left side of the gurney. The patient then underwent infiltration of local anesthetic into the soft tissues overlying the tendon sheath of the left long finger. Once adequate local anesthetic had been obtained, the extremity was prepped and draped. After prep and drape, a timeout was performed. After routine timeout, we proceeded with the procedure. I exsanguinated the extremity with an Esmarch bandage and inflated the tourniquet to 250 mmHg. I then made an oblique incision overlying the tendon sheath of the left long finger starting at the distal palmar crease and then following along the crease. Sharp dissection through the skin was followed by blunt dissection. I exposed the tendon sheath, and under direct visualization, I excised it. There was presence of a ganglion on the tendon sheath of the left long finger. This was excised and passed off as a waste. I completed opening the tendon sheath and then deflated the tourniquet. I irrigated the wound thoroughly with sterile normal saline. I obtained hemostasis with bipolar cautery and pressure. I irrigated the wound thoroughly and then closed the incision using 5-0 nylon. I washed and dried the extremity. I applied dressings of Xeroform, sterile gauze, sterile Kling, and tape. The patient was then awakened and taken to the recovery room. She arrived in the recovery room in stable condition still under the influence of IV sedation. All counts correct x2
Thank you for taking the time to read my post.
