Does anyone have any helpful links or resources that explain when to bill recurrent (25112) vs. primary (25111) wrist ganglion removal? My provider always comes back to me stating that ALL ganglions are recurrent and wants to bill recurrent removal 25112 instead of primary 25111 on every patient, regardless of whether or not the patient has had prior treatment on the ganglion. I would like to have some definitive documentation to back up the correct way to bill/code for a ganglion cyst removal. Thanks!
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Tag Archives: wrist
Wrist arthrotomy
My provider did an open wrist joint exploration which leads me to codes 25040 & 25101. All he did was exploration. What would lead me to chose one code over the other?
Can anyone explain the difference between codes 25040 & 25101? I understand 25101 is for joint exploration; with/without biopsy, with/without removal foreign body. However the only difference I see between these codes is the word ‘drainage’ in code 25040.
In code 25040 do you need to perform exploration AND either drainage or foreign body removal or is any one of the 3 (exploration OR drainage OR foreign body removal).
I appreciate any and all feedback.
Thank you!!
Wrist fusion code
What code is used for a STT fusion of the wrist?
Wrist ECU tendon deepening in ulnar groove and 6th comp reconstruction
Hi there! Are there any possible wrist tendon experts that have come across this procedure.
Pt has ECU subluxation
The surgeon makes an incision down to the 6th dorsal compartment and dictates that it is slightly loose. THe ECU would mobilize in this, however, the ECU was not torn out of the sheath itself. This was then elevated subperiosteally from the ulnar side in order to keep the ECU within its subsheath. The tendon through the subsheath did not show any obvious tearing. At this point, with superiosteal dissection this allowed the facilitation of the ulnar groove, this was flattened slightly. A bur was used in order to deepen this to about 2mm. At which point placing a Freer in here I was able to appreciate a healthy concavity that would hold the ECU. The ECU was placed into the groove that was graded and held with a pickup and then bringing the wrist through ROM, pronation, supination multiple times there was no sublutation what was appreciated.
A mini Mitek anchor was place dont he ulnar border where the initial inciions had been made on the ECU sheath and then a second suture anchor just proximally. Both anchors were firm and stable. Then a mattress suture was placed in the subsheath as well incorporaing the extensor retinaculum of the 6th compartment and this located the ECU within the groove. This second anchor also had a mattress suture placed again incorporating both layers. These sutures were then placed in a running fashion proximally and distally to both acnchors creating a stable sheath.
The closest procedure I see is 25275 (no graft involved) possibly a comparable to unlisted.
Thank you in advance
Internal wrist derangement
I am having a hard time with this procedure. My doc has asked that I find new ways to code and this procedure is one he would like coded differently.
Diagnosis:
1. Internal derangement, right wrist.
Procedure:
1. Arthroscopy radiocarpal/midcarpal joint.
2. Laser ligamentoplasty of scapholunate
3. Laser ligamentoplasty of lunotriquetrum
4. Laser ligamentoplasty of triangular fibrocartilage complex (TFCC)
5. Debridement and synovectomy of the radialcarpal and midcarpal joint.
6. Repair of scapholunate partial thermal shrinkage
6. Repair of lunotriquetrum partial thermal shrinkage
6. Repair of triangular fibrocartilage complex partial thermal shrinkage
The index and long fingers were placed in finger trap traction. Distraction was carried across the level of the radiocarpal joint. One radial portal was established for outflow, a 3-4 was established as a working port, and a 4-5 was established as a laser port. The camera was inserted into the radiocarpal joint. the radio carpal joint was inspected and the scapholunate and lunotriquetral spaces ere identified. A moderate around of synovitis was encountered along the margin of the radio carpal joint.
The laser was introduced through the 4-5 portal and a synovectomy was performed of the radiocarpal joint. The laser was the brought to the level of the triangular fibrocartilage complex where a partial tear of the TFCC was encountered.
At the level of the pre-styloid recess, a laser ligamentoplasty was performed of the triangular fibrocartilage complex. The laser was brought to the scapholunate space and ligamentoplasty was and capsulodesis was performed, tightening the scapholunate space. The TFCC was approached and a marked amount of synovitis was noted. A synovectomy was performed at the TFCC. Laser ligamentoplasty and debridement was then performed of the TFCC. With the holmium laser in a portal site, the scapholunate was repaired vial thermal shrinkage, the partial tear of the lunotriquetral was repaired via thermal shrinkage, and the TFCC was repaired via thermal shrinkage.
I use 29846 to cover the Arthroscopy, debridement, and synovectomy.
I also use 25320 for ligament repair via thermal shrinkage. 25320 MUE is only 1.
Are there any other codes I should be using to code this procedure.
Elbow and wrist surgery
Need to see if I was correct in billing these procedures together
Dx: Lateral epicondylitis with common extensor tendon tear
Carpal Tunnel
Cubital Tunnel
Submitted CPT 24341 for repair of tendon, elbow
64718 Ulnar nerve release at elbow
64721 Carpal Tunnel Release median nerve
Insurance is denying 64718 and 64721 as inclusive to the tendon repair of 24341
Am I correct in my billing , or do I have an appeal. I think I do, but would like some other coders opinions.
Thank you,
Carol