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Not your normal question CTS release with Tenosynovectomy

Hello all,

I have been researching this topic, however most of the information I have found (even in these forums) are a few years old and/or have information backwards. Plus I am wanting to get a general idea what everyone is doing now, in 2018.

I am aware that 64721 bundles into 25115 when both carpal tunnel release is performed and a flexor tenosynovectomy is performed in the wrist at the same surgical session. The schools of thought I am seeing are:
It bundles, only code 25115
Code the original reason the procedure was performed (came in for ctr and they also performed a tenosynovectomy, bill for ctr release)
If there were/are separate diagnosis for each disorder, you can bill the 64721 with a 59.

I do not have a note to share, I am just trying to get the "pulse" as it were, of the protocols/directives and gather information all you wonderful coders may have.

Thank you!

Medical Billing and Coding Forum

Extensor Tenosynovectomy

What code is everyone using for extensor tenosynovectomy of the hand/fingers. 26145 will not work because that is for flexors.

The Dr. says Extensor tenosynovectomies were performed on the EDC of the index, long, ring, and small; EDQ small; EIP index.

I cant find a code for extensor tenosynovectomy of the hand.

Medical Billing and Coding Forum

Trigger finger vs. Tenosynovectomy

Possible a dumb question. Can someone explain the difference between trigger finger release and tenosynovitis. I actually know the difference, but the op note is a little confusing.

Pre-op DX: Index, Long, Ring, and Small flexor tenosynovitis

Post op DX: Index, Long, Ring, and Small A1 pulley release and flexor tenosynovectomy.

Procedure: Index, Long, Ring, and Small A1 pulley release and flexor tenosynovectomy.

Procedure: A 15 blade was used to make a transverse incision to level of A1 pulley. This was carried down to subcutaneous tissue using tenotomy scissors. The neurovascular bundles were identified on each side of the fiber osseous sheath and retracted with nerve retractors placed within the confines of the wound. Once the A1 pulley was identified, an axial incision was made in the midline of it dividing it completely. This was carried proximally and distally with tenotomy scissors. Tenotomy scissors were used to perform FLEXOR TENOSYNOVECTOMY for the index, long, ring and small fingers. After this was done again the neurovascular bindles were inspected and found to be intact. The Ragnell retractor was used to pull the tendon into the wound to ensure that it had been completely released from the pulley. The tourniquet was let down. Sterile dressing was applied.

I realize it says the Dr. checked to see that the tendon was released from the pulley, but wouldn’t I code for the tenosynovectomies (26145) and use tenosynovitis (m65.842) as my DX? The A1 pulley release cpt code is 26055 is for trigger finger. And trigger finger and tenosynovectomy are inclusive of each other. For the office visits prior to the surgery the Dr. is using the trigger finger dx. So what should I be coding this as?

Medical Billing and Coding Forum