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Orthopedic Coding Alert

A Procedural Coding Primer:

Improve Pay Up for Surgery Of the Bones of the Hand

In the multifaceted arena of hand surgery, the range of available codes and the number of small bones in the hand and fingers add up to coding challenges for even the seasoned orthopedic coding specialist. Understanding the definitions and procedures of common hand surgeries is the first step to accurate coding and optimum reimbursement.

Definitions of Common Hand Surgeries

Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C., identifies some of the most common hand surgeries where bone is repaired or otherwise affected.

Open treatment of fractures: An incision is made to set or repair a broken (fractured) bone in the hand. In hand surgery, an open treatment is most likely to occur when the nature of the fracture prevents a closed setting. Common open procedures for the hand include 26615 (open treatment of metacarpal fracture, single, with or without internal or external fixation, each bone), 26665 (open treatment of carpometacarpal fracture dislocation, thumb [Bennett fracture], with or without internal or external fixation), 26735 (open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with or without internal or external fixation, each), 26746 (open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, with or without internal or external fixation, each) and 26765 (open treatment of distal phalangeal fracture, finger or thumb, with or without internal or external fixation, each).

Arthroplasty: This is the creation of an artificial joint, or an operation to restore as far as possible the integrity and functional power of a joint.

In hand surgery, arthroplasty most commonly is used to repair or correct cartilage damage and joint dislocations caused by various forms of arthritis, or to correct ankylosis. Common arthroplasties of the hand include 26530-26531 (arthroplasty, metacarpophalangeal joint) and 26535-26536 (arthroplasty, interphalangeal joint).

Capsulodesis: This is the correction of joint instability or dislocation of joints caused by injury or disease.

The physician cuts into the capsule of the joint, and then attaches the capsule with sutures to either the proximal or distal ends of the bones to provide stability. Common capsulodesis procedures include 26516-26518 (capsulodesis, metacarpophalangeal joint).

Editors note: Choose only one code from this series to indicate the total number of digits treated.

Capsulectomy or Capsulotomy: These terms indicate the creation of an opening through a capsule or through scar tissue that has formed around a joint or bone.

In hand surgery, this procedure is used to correct contracture of the joint. Common procedures for the hand include 26520 [...]

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