Orthopedic Coding Alert

Question: What code should I use for extensor tenosynovectomy of the hand/fingers? Notes indicate the physician performed extensor tenosynovectomies "on the EDC of the index, long, ring, and small; EDQ small; EIP index." I reported 26145 and received a denial.

Tennessee Subscriber

Answer: The most likely reason the payer denied 26145 (Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon) is because the code is designed for procedures on flexor tendons. You might also consider 25118 (Synovectomy, extensor tendon sheath, wrist, single compartment) - but you can only report this code when the provider performs the tenosynovectomy in a single wrist compartment.

Try this: Since there is no code to describe tenosynovectomy in the hand, report unlisted code 26989 (Unlisted procedure, hands or fingers).