... and you may not even know it
The next time your surgeon documents a trigger finger release, double-check your code choice to make sure you report 26055, not the tenosynovectomy code 26145 or the tenolysis code 26440. What's the difference? It could be about $460 more in revenue than you deserve.
Know the Difference Between 3 Codes
Hand surgeons who treat trigger finger (727.03) often start the patient's treatment with non-invasive services, such as trigger finger injections (20550, Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar -fascia-]). But when the patient's symptoms don't improve, surgeons may choose to perform a trigger finger release.
The problem: Some coders review trigger finger release documentation and overlook the appropriate code, 26055 (Tendon sheath incision [e.g., for trigger finger]). Some coders say that they may instead look to one of two other codes:
- 26145--Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon
- 26440--Tenolysis, flexor tendon; palm OR finger, each tendon.
-These codes should only be used in very specific, relatively rare instances,- says Carl Weiss, MD, a hand surgeon at OrthoMemphis PC in Memphis, Tenn. -These codes really have no place in the treatment of straightforward trigger finger.-
And if you planned to report both 26055 and 26145, think twice. -Indeed, under the global-service guidelines, tenosynovectomy is included in trigger finger release and it would be considered unbundling to bill both,- Weiss says. And both National Correct Coding Initiative (NCCI) and American Academy of Orthopaedic Surgeons (AAOS) guidelines include tenosynovectomy as a component of 26055.
Diagnosis coding clues: If you can't determine which code is appropriate, the patient's diagnosis may give you a hint. Surgeons usually perform the trigger finger release described by 26055 for patients with trigger finger. But -in patients with rheumatoid arthritis, you are supposed to perform a tenosynovectomy instead of a trigger finger release, to help prevent ulnar drift,- Weiss says. Therefore, if you see documentation of tenosynovitis due to rheumatoid arthritis (714.0 and 727.01), there's a safe bet you shouldn't be reporting 26055.
If your hand surgeon treats multiple trigger fingers during the same operative session, you should append the applicable finger modifiers (FA-F9) to the CPT code. -You should only use modifier 59 (Distinct procedural service) if you absolutely have to,- says Annette Grady, CPC, CPC-H, director of educational services with Coding Metrix. -The -F- modifier should not require the additional use of modifier 59.-
Therefore, if your surgeon performs trigger finger releases on the thumb and second finger of the right hand, you should report 26055-F5 and 26055-F6.
If your insurer does not accept the finger modifiers, you should revert to modifier 59 for the [...]