1. Vanessa Marshall
   Posted 4 months ago #
   

   I work for a group of Hand/Wrist specialists and when they remove a wrist ganglion from a patient, they often do a radiocarpal or midcarpal arthrotomy. We keep getting denials and I need some help with this as I'm still fairly new to coding.

   My question is this: Is it proper to code for both procedures seperately (ie 25111 for ganglion removal and 25101 for wrist arthrotomy w/ exploration)?

   If not, would it be more appropriate to code 25040 for wrist arthrotomy w/ exploration, drainage, or removal of foreign body by itself?

   I realize it's possible that I'm completely wrong on this and should only be coding 25111 for removal of a ganglion without any other codes.

   Any help or insight I can get would be greatly appreciated!

2. SuperCoder
   Posted 4 months ago #
   

   Let's not be confused by the closely related code description. The Key is what is the Medical Necessity and what is the procedure documented.
   If the physician has just made an incision around the ganglion in the wrist, be it a radiocarpal or midcarpal, for dissecting and freeing the ganglion from the surrounding tissues, then it is simple 25111.
   *
   With medical necessity being excision of ganglion, if the surgeon made documentation of wrist arthrotomy for excision of ganglion, then it is correct to code 25111 only. But, with same medical necessity if the surgeon makes radiocarpal arthrotomy with exploration with excision of ganglion, without justification of the reason to perform wrist exploration, then it is intended for an over-billing, and we should not code 25040 along with. Here, before we code 25111, we should send a Clarification Note to physician for reason for performing exploration.
   *
   But, if there is a justification of doing exploration or foreign body removal, i.e., there is medical necessity, then you can 25040 or 25101 as appropriate based on description. In that case procedure 25111 if performed with the same incision on same session, becomes inclusive, so may not be coded.

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