Wiki Mallet Finger 26432

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apoland

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Hello,

Recently, our practice has been discussing use of 26432. The lay description from OPTUM states "The physician repairs the distal insertion extensor tendon without incising the skin. The physician uses a splint to pin the finger in an extended position. If extensive damage occurred during injury, pins may be used to stabilize the joint." We are trying to determine if this is supported by splinting alone in the office setting, or if it requires closed reduction/manipulation prior to splinting. Does anyone have insight or resources that discuss this?

I appreciate any help.
Thank you,
Autumn
 
Good question.
Some might be looking for the words manipulation/closed reduction to report it. Although, the code description does not say "closed reduction", it just says closed treatment. In further reading some other lay terms for the code say "The avulsion is reduced" but that is not found official guidelines.

Would someone ever have mallet finger which didn't require some sort of manipulation before/during splinting? That's the whole point of the splint. The splint is essentially "reducing" the finger over time by holding it in extension.

I don't think this is the same concept as the fracture closed treatment with manip./without manip. codes. Even though they can have a bony avulsion. The code description doesn't state the word manipulation, it says w/ or w/o perc pinning. I think it also depends on how it is described by the physician documentation, is it a soft tissue mallet or a bony mallet? If the documentation supported it, and the physician clearly wanted to bill the global (keep in mind these have 90 day global which has to be explained to the patient why they have a higher fee, global, etc.) I would code it. Also keep in mind, if the provider wants to charge an E/M on the same date that documentation has to possibly support a modifier due to E/M & 90 day code on the same date. You would also want to check individual payer guidelines that may or may not exist and track it after to make sure it was paid.

 
Thank you for the detailed response. We've gone back and forth on the documentation requirement and this helps clear a few things up. I appreciate your time.
 
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