Orthopedic Coding Alert

Question: The orthopedist performed four procedures during the same surgery: left elbow subcutaneous ulnar nerve transposition; left elbow arthroscopic capitellar microfracture; left elbow arthroscopic spur excision, chondroplasty, and decompression; and left hand complex open Dupuytren contracture release and cyst excision. How should we code everything?

Alabama Subscriber

Answer: Report two codes for the elbow procedures:

29999 (Unlisted procedure, arthroscopy) for the microfracture procedure. Compare to 29879 (Arthroscopy, knee, surgical; abrasion arthroplasty [includes chondroplasty where necessary] or multiple drilling or microfracture) with 17.18 national relative value units (RVUs) for facility or non-facility.

29837 (Arthroscopy, elbow, surgical; debridement, limited) or 29838 (... debridement, extensive) for the spur excision and chondroplasty.

When performed as a stand-alone procedure, you would report 64718 (Neuroplasty and/or transposition; ulnar nerve at elbow) for the ulnar nerve transposition.

Submit 26123 (Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting [includes obtaining graft]) for the Dupuytren's release. If the hand procedure included additional digits, add +26125 (... each additional digit [List separately in addition to code for primary procedure]) as appropriate.

Excision check: Depending on the cyst location, you might be able to report excision in addition to the Dupuytren's release. Check your surgeon's notes for the cyst location and size to code accordingly when justified.