Orthopedic Coding Alert

" Proper coding for procedures performed on multiple fingers and toes is a challenge because there are as many different modifiers designating which digit is affected as there are fingers and toes. Familiarizing yourself with these modifiers, as well as with ways to bill for the same procedure on multiple digits, leads to correct coding and proper reimbursement. Finger Codes Part of the challenge of coding finger procedures is the staggering number of codes in the Hand and Fingers section (26000 series) of CPT 2002. The codes cover fasciotomies, tenotomies, synovectomies, repair or lengthening of tendons, fracture reduction, arthrodesis and amputation. Common injuries to the fingers are usually the result of trauma (crushing accidents, lacerations, falls) or repeated stress through occupational or recreational pursuits (such as trigger finger).

Many code descriptors for finger surgeries include the word each"" (e.g." 26535 Arthroplasty interphalangeal joint; each joint) indicating that the code is intended for surgery on one digit or joint only. Some code descriptors specify the number of digits per surgery (e.g. 26517 Capsulodesis metacarpophalangeal joint; two digits). Other code descriptors are not as specific (e.g. 26568 Osteoplasty lengthening metacarpal or phalanx).

Ensuring that the claim form accurately represents the surgeries performed means not only understanding these distinctions in code descriptors but also appending proper modifiers to each CPT code. Since most surgical procedures do not designate which digit is being repaired identifying the digit in question is essential. HCPCS Level II modifiers found on the inside front cover of CPT 2002 are appended to CPT codes for this purpose. Modifiers -FA and -F5 apply to the left and right thumbs respectively; -F1 -F2 -F3 and -F4 apply to digits on the left hand; -F6 -F7 -F8 and -F9 apply to digits on the right hand. These modifiers signal to the carrier that multiple entries of the same code are not a duplication but rather that the same procedure was performed on different digits.

For single or multiple procedures of the fingers the appropriate modifier is chosen to indicate which finger was worked on.

For example the claim for a patient who has a crush injury to fingers of the right hand with open fracture of the middle phalanges and requires an open reduction of each fracture might read as follows:

816.13 (Fracture of one or more phalanges of hand; open; multiple sites)

26735-F6 (Open treatment of phalangeal shaft fracture proximal or middle phalanx finger or thumb with or without internal or external fixation each-Right hand second digit)

26735-F7 ( Right hand third digit)