Orthopedic Coding Alert

Question: The surgeon removed external fixation from the left distal radius and ulna; performed manipulation of the left wrist; completed manipulation to digits 1-5 to increase IP joint motion to the left palm; and manipulated the DIP, PIP, and MCP joints to gain range of motion. How should I code all these individual manipulations? Tennessee Subscriber Answer: Your primary code is 20694 (Removal, under anesthesia, of external fixation system); the wrist manipulation is bundled with the removal of external fixation for that anatomic site, so you won't separately report that. Finger joint manipulations also are bundled with 20694, but you can code them in this instance because they are separate sites from the wrist. Report 26340 (Manipulation, finger joint, under anesthesia, each joint) with the appropriate digit modifiers from F1-F9. Also append modifier 59 (Distinct procedural service) to each finger manipulation. Carrier watch: The code descriptor states "each joint," so [...]