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TFCC/DRUJ ARTHROTOMY

Pamela Posted Wed 09th of January, 2019 13:05:32 PM
Our MD performed an initial arthroscopic debridement of the TFCC joint, however; switched to arthrotomy for a DRUJ synovectomy. I know that I am unable to bill CPT Code 29846 with 25105, but I wanted the opinion of someone else on billing CPT Code 25107 instead of just CPT 25105. The op-report is below. Thank you for your assistance. Procedure: Patient was taken to the operating and identified. A right axillary tourniquet was applied and the arm was prepped and draped in the usual sterile fashion. A sterile marking pen was utilized to outline the bony and soft tissue topography of the palm and wrist.The arm was exsanguinated with an Esmarch bandage and tourniquet was inflated to 225 mmHg. Local anesthesia was administered in the planned areas of incision with a mixture of 1% lidocaine with epinephrine and 0.5% Marcaine with epinephrine. 3/4, 4/5, 6-R, and C6-U portals were mapped out as well as a proximal DRUJ portal. The arm was suspended from an overhead traction tower with sterile finger traps. The radiocarpal joint was injected with normal saline solution. The arthroscope was first placed in the 3/4 portal after skin incision and cannula placement. Next the 6-U portal was used for drainage utilizing a 19-gauge needle laced under arthroscopic visualization from inside the joint. The 4/5 and 6/R portals were also established with intra-articular visualization. Joint structures were systematically evaluated with gross pathology as noted above. A full-radius shaver was utilized to perform synovectomy. A suction punch was additionally used to resect unstable portions of the torn TFC. The proximal DRUJ portal was then established and the arthroscope was introduced with gross pathology as noted above. The radiocarpal joint had previously been lavaged and suctioned of all ring synovial debris. The traction was removed and the forearm was placed prone on the operating table a one centimeters incision was made at the proximal edge of the DRUJ with dissection carried down through subcutaneous tissue. The joint was entered and the DRUJ was directly visualized. Synovectomy was performed with synovial rongeurs and resected tissue was sent to pathology for evaluation. No instability of the DRUJ was noted following debridement in either full supination, pronation, or neutral rotation. There is no evidence of ECU tendon subluxation.
SuperCoder Answered Thu 10th of January, 2019 06:04:04 AM

Hi,

As per the above mentioned report, the appropriate CPT code will be 25105.

In CPT 25107, surgeon performs a distal radioulnar arthrotomy for repair of a triangular cartilage complex, whereas in above mentioned report surgeon has only performed synovectomy for DRUJ and arthroscopic resection of unstable part of torn TFC, so CPT 25107 is incorrect code.

Thanks

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