Orthopedic Coding Alert

Question: In a patient diagnosed with synovitis with first dorsal compartment tendinitis and ganglion formation from extensor carpi ulnaris (ECU), our surgeon did the following procedures:

1. Exploration, volar radial mass, with first dorsal compartment release and excision of tenosynovitis
2. Excision, ganglion formation from ECU and neurolysis of dorsal cutaneous nerve

New Jersey Subscriber

Answer: You report 25111 (Excision of ganglion, wrist [dorsal or volar]; primary) for the ganglion that your surgeon is excising. You do not separately bill for the synovectomy in this situation.

According to the American Academy of Orthopedic Surgeons (AAOS) Complete Global Service Data Guide, synovectomy codes, 25105 (Arthrotomy, wrist joint; with synovectomy), 25115 (Radical excision of bursa, synovia of wrist, or forearm tendon sheaths; flexor), 25116 (Radical excision of bursa, synovia of wrist, or forearm tendon sheaths; extensors) or 25118 (Synovectomy, extensor tendon sheath, wrist, single compartment), are included in the global charge for 25111. You can also charge 64704 (Neuroplasty; nerve of hand or foot) for the neurolysis of the dorsal cutaneous nerve.