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Hand/Fingers – Excision cyst (tendon sheath), Excision Osteophytes (phalanx)

I would greatly appreciate help with references for the following operative scenario. I have been given codes, 26160 and 26110 (these bundle), I find references that suggest use of 26160 (excision of cyst off tendon sheath) and 26236 (osteophyte removal).

For the operative case below would it be considered over-coding to code: 26235, f7; 26236, 51, f7; 26160, 59, 51,f7

I have researched myself to the point of total confusion – thank you to those more experienced than me and taking time to help a fellow coder out !!

TECHNIQUE:
Patient was taken to the operating suite and after the induction of adequate general anesthetic the right upper extremity was prepped and draped in the usual sterile fashion. An Esmarch was used to exsanguinate the limb and the tourniquet was inflated to 250 mmHg. At this point in time an L shaped incision was made over the distal aspect of the right long finger have a large 1.5 x 1.5 cm lesion consistent with probable mucoid cyst. A radially based flap was elevated and dissection was carried down to the extensor sheath. There was a complex multi lobulated cystic lesion that was carefully excised off the extensor insertion and distal interphalangeal joint capsule radially. This was sent for pathologic identification. We carefully retracted the extensor mechanism and perform a distal interphalangeal joint arthrotomy with debridement of large dorsal osteophytes of both the base of the distal phalanx and the head of the middle phalanx. This was all sent for pathologic confirmation. The wound was then thoroughly irrigated. It was loosely closed with 4-0 nylon. Xeroform, 4 x 4’s, and a compression wrap was applied to the right long finger. The patient tolerated this procedure well and went to recovery room in stable.

Medical Billing and Coding Forum

Excise Mucous Cyst & debride osteophytes left ring finger DIP Joint

Radiographic Findings consistent with mucous cyst & significant degenerative arthritis in the DIP joint.

Op Report: A curvilinear incision was made over dorsum of the left ring finger DIP joint. Dissection was carried through subcutaneous tissue. Full-thickness skin & subcutaneous tissue flaps were elevated. The mucous cyst was localized pretty centrally over the extensor mechanism distal to the DIP joint. The cyst was identified & mobilized & excised and originated from the dorsal ulnar corner of the joint. Both the dorsal Ulnar & dorsal Radial corner of the joint were identified & osteophytes were debrided with a rongeur off the base of the distal phalanx. The penrose drain was removed & bleeding controlled with electrocautery. The incision was irrigated & closed.

Coded with 26210 & 26160. One of our coders says per Margie Vaught that this is how we should be billing these. I feel that 26160 would include the debridement of the osteophytes since all through same incision. Can anyone advise on this issue. I found several questions similar to this, but am confused on why would these billed together when done through same incision. CPT Code 26210 is a Column 1 code with 26160 being a column 2 code, but unbundling is allowed. Thanks in advance for anyone who may be able to help.

Medical Billing and Coding Forum