Wiki MPJ UCL Tears: Coding Advice?

[canbrody]

I have a hand surgeon who treats MPJ UCL tears regularly. His op notes discusses reconstruction, with graft and internal fixation. The fixation is usually a pin to hold the ligament in place, sometimes a screw.

He often chooses CPT 26540 for repair of ligament plus 26735 which is open treatment of fracture w/ internal fixation. The body of the notes do not discuss fracture reduction at all and none of the DX include any type of finger fracture. I am leaning more torward CPT 26541 which is the reconstruction of the collateral ligament, including graft.

Example verbiage of procedure summary:

Body (left out the x-ray and closure section)

 

[iowagirl77]

I have a hand surgeon who treats MPJ UCL tears regularly. His op notes discusses reconstruction, with graft and internal fixation. The fixation is usually a pin to hold the ligament in place, sometimes a screw.

He often chooses CPT 26540 for repair of ligament plus 26735 which is open treatment of fracture w/ internal fixation. The body of the notes do not discuss fracture reduction at all and none of the DX include any type of finger fracture. I am leaning more torward CPT 26541 which is the reconstruction of the collateral ligament, including graft.

Example verbiage of procedure summary:
View attachment 7191
Body (left out the x-ray and closure section)
View attachment 7192

I'm only seeing repair- 26540. Reconstruction (26541) would require graft use (reference: https://www.kzanow.com/coding-coaches/knee-ligament-repair-vs-reconstruction), which I do not see documented here. ORIF is not supported by the diagnosis or procedure, so you might query the surgeon for their perspective.

 

[kdlberg]

They can't fix a fracture that doesn't exist. If it isn't documented, it doesn't exist. 26541 sounds like a better choice.