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2nd thoughts

louise Posted Mon 04th of March, 2019 17:34:01 PM
hand dorsal lipoma excision, 3rd MCP joint synovial debridement lipoma no measurement given, debridement keep coming up with a bx code. Please any advise is welcome. thanks
SuperCoder Answered Tue 05th of March, 2019 06:41:58 AM

Thank you for your question.

The provided documentation does not clearly indicate the services performed on the billed date of service.

 

Is the area of dorsal hand lipoma and 3rd MCP joint synovial debridement lipoma same?

Was the biopsy performed as diagnostic? Did the excised lipoma included the biopsy location that was performed?

Why was synovial debridement performed?

 

The additional information will help us determining the appropriate codes.

 

Thanks

louise Posted Tue 05th of March, 2019 09:06:43 AM
longitudinal incision was made overlying the mass which was located in the space between the distal 2nd and 3rd metacarpal bones. The fatty mass was identified. It was dissected free from all surrounding subcutaneous attachments and was then excised and passed off the table. In gross appearance, it appeared to be an unencapsulated lipoma. After the lipoma was removed in its entirety, the 3rd MCP joint was opened. An incision was made between the central tendon and the sagital band. A dorsal capsulotomy was performed. All abnormal appearing synovium was debrided.
louise Posted Tue 05th of March, 2019 09:06:51 AM
longitudinal incision was made overlying the mass which was located in the space between the distal 2nd and 3rd metacarpal bones. The fatty mass was identified. It was dissected free from all surrounding subcutaneous attachments and was then excised and passed off the table. In gross appearance, it appeared to be an unencapsulated lipoma. After the lipoma was removed in its entirety, the 3rd MCP joint was opened. An incision was made between the central tendon and the sagital band. A dorsal capsulotomy was performed. All abnormal appearing synovium was debrided.
SuperCoder Answered Wed 06th of March, 2019 05:33:02 AM

Thank you for the additional information.

 

As per the provided documentation, appropriate code for 3rd MCP joint dorsal capsulotomy will be CPT® code 26520. Append modifier-59 (Distinct Procedural Service) to CPT® code 26520, as there is a bundling conflict between both the codes.

 

For Lipoma excision between distal 2nd and 3rd metacarpal bones, appropriate CPT® code will be 26115

 

Note: Append modifier F2 (Left hand, third digit) OR F7 (Right hand, third digit) to CPT® code 26520; basis the anatomical site in your documentation.

 

Hope it helps.

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