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.

 

[amyjph]

There is no tendon or fascial graft described in the op note snip above. An internal brace is not a graft. This is not 26541. Agree with Susan.
This is 26540. According to AAOS GSD, repair of a fracture if attached to the collateral ligament is included in 26540. However, that is not even described above either.
Sounds like there is probably a template, and/or a standard code list being submitted for this when not every procedure is the same. Or, someone saw the words "open reduction internal fixation" and immediately just thought that meant ORIF of a fracture and coded by the header and did not read the op note. Or, this op note needs attention from the provider.
In this snip above, the MCP joint open reduction is being accomplished by doing the 26540.

The guide pins from the Arthrex being placed in the head and base is part of 26540.

This is a key reason why you cannot code from a header only, and you never trust what codes the surgeon picks (lol) or attaches to the op note. Half the time it is just a template anyway. Providers are also limited by radio boxes or clickable templates in EMRs which just give them a list and click something that "looks" right.
You would also be well served to obtain the AAOS Complete Global Service Data for Orthopaedic Surgery which helps coders (and others) determine what is considered included or not in a main CPT. Keeping in mind that may not always match what a payer thinks.