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Nodule excision thumb and Heberden's node removal with fusion (26860)

Tanesha Posted Mon 25th of March, 2019 21:38:57 PM
The nodule was excised from the snuffbox, but the Path is stating 3 small bone fragments. Agree with 26160-F5, 26860-F7? Excerpt from OP note: First the incision at the base of the thumb was a modified Brunner incision. A cartilagenous nodule was encountered in the anatomical snuffbox. This was at the level of the abductor pollicis longus tendon. The nodule was excised, then skin was closed....Dorsal aspect of the right middle finger DIPJ was opened by a T shaped incision. Heberden's nodes which were of a bony nature were roungered. The extensor tendon was divided. The 2 Heberden's nodes were freed with rongeur and the articular surface of the DIPJ was removed with an oscillating saw creating a V conformation. The wire was then tightened and there was sufficient compression and was tightened to create tension across the new arthrodesis.
SuperCoder Answered Tue 26th of March, 2019 10:32:11 AM



Thanks for your question.

As per the documentation provided the CPT codes seems appropriate to use. Since, the nodule was excised the post op diagnosis will be given for the nodule only.  Therefore, code 26160-F5 will be appropriate for excision of nodule. Post surgery, path report suggest 3 small bony fragments then the diagnosis for the bony fragment  will be considered on path report only.

Hope this helps.


Tanesha Posted Tue 26th of March, 2019 22:19:04 PM
Thank you. So, you agree that the Heberden's nodes excision isn't coded as this is apart of the fusion therefore only the two codes stated?
SuperCoder Answered Thu 28th of March, 2019 11:20:20 AM



Heberden's node excision should be included with the arthodesis code since the anatomical location of Heberden's nodes and arthrodesis is same. If the provider performed any extra work modifier 22 can be appended with arthrodesis code, if the criteria for modifier 22 is met.

>In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:

>–Increased intensity

>–Additional time

>–Technical difficulty

>–Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician

>An unusual procedure is not when the physician took only a few extra minutes on the patient’s case or when the physician documents that the procedure was only slightly more difficult. There is an average range of difficulty for every procedure. A procedure could be slightly more difficult and still meet the definition of the procedure and not warrant appending modifier 22.

>Hope this helps.


Tanesha Posted Tue 02nd of April, 2019 10:12:52 AM
Ok, thank you for your help.
SuperCoder Answered Wed 03rd of April, 2019 01:29:21 AM

Happy to Help!

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