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Orthopedic Coding Alert

Guest Column:
Denise Paige, CPC--Ace Wrist Reconstruction Coding With 4 Quick Tips

Initial surgery or redo?  Confirm status before you submit your claim

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 most seasoned orthopedic coding specialist. But as long as you understand what you should include in the main surgical procedure and what you should report separately, you should be able to bill hand procedures like a pro.

If you look at the following op report example, you-ll see why you have to use all of your resources before you code a hand surgery. A combination of the AAOS- Complete Global Service Data for Orthopaedic Surgery (GSD) guide, the National Correct Coding Initiative (NCCI) edits, your CPT and ICD-9 books, insurers- guidelines, and other resources should help you determine which services are billable.

Preoperative diagnosis: Complete disruption of the triangular fibrocartilage complex left wrist; left distal radioulnar joint instability; disruption of the extensor carpi ulnaris (ECU) tendon sheath; and dislocation of the extensor carpi ulnaris tendon.

Procedure overview: Secondary repair of the triangular fibrocartilage complex of the left wrist, extensor carpi ulnaris tenodesis, and reconstruction of the extensor carpi ulnaris tendon sheath. Op Note: Trace the Hand Surgeon's Work The pertinent details of the op report: I made a 4-cm incision over the dorsal ulnar aspect of the left wrist. I incised the retinaculum at the interval between the fifth and sixth compartments and immediately encountered hemorrhagic tissue, which I sharply excised.
 
I found that the triangular fibrocartilage proper had ruptured from the fovea at the base of the ulnar styloid and had retracted into the ulnocarpal joint. I incised the capsular tissues of the lunocarpal joints and performed a synovectomy.

I advanced the triangular fibrocartilage to the fovea and placed multiple drill holes at the site with a 0.035 Kirschner wire. I passed three Vicryl mattress sutures through the drill holes into the ligament for its reat-tachment. Before knotting the sutures, I inspected the extensor carpi ulnaris tendon sheath and found that it had ruptured, allowing subluxation or dislocation of the extensor carpi ulnaris tendon. I performed an extensor carpi ulnaris tenodesis by dividing the ulnar half of the ECU tendon proximally and left it intact distally.

I procured a 7-cm strip of the ulnar half of the tendon and withdrew it distally and passed it just beneath the distal ulnar to the level of the ulnar neck proximal to the sigmoid notch. With a power bur, I created a channel in a dorsal-to-volar direction [...]


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