Orthopedic Coding Alert

Also, there are imaging services that could come before the surgery.

When a patient ruptures a wrist/forearm tendon, the orthopedist is likely to get the call on the repair.

They could also be the provider that diagnoses the condition in the first place.

As a coder, you have to be on the lookout for three separate types of wrist/forearm tendon repairs, as well as services that lead up to the repair.

Check out this advice on coding wrist/forearm repairs, so you’ll be ready for anything that heads your way.

Know What Services Lead to Repairs

“Wrist/forearm tendon ruptures are most commonly diagnosed with clinical assessments; however there are a few diagnostic tests that can be used to help confirm the diagnosis,” says Jessyka Burke, BSHA, CPC, OSC, CASCC, coding specialist at Cascade Orthopaedics in Auburn Washington.

There are also tests such as magnetic resonance imaging (MRI), ultrasound (US), and X-rays available to determine the status of the patient’s wrist. “MRI and/or ultrasound are the best diagnostic tools to use to help with the confirmation of the tendon rupture,” Burke continues.

When the orthopedist performs a clinical assessment, you’ll most likely be reporting the service with a code from the 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection,15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.) family.

If the provider decides on an MRI, the codes you’ll most likely be using for the service are:

• 73221 (Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s))
• 73222 (… with contrast material(s))
• 73223 (… without contrast material(s), followed by contrast material(s) and further sequences)
• 73225 (Magnetic resonance angiography, upper extremity, with or without contrast material(s))

If a US is used, you’ll most likely choose between 76881 (Ultrasound, complete joint (ie, joint space and peri-articular soft-tissue structures), real-time with image documentation) and 76882 (Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation).

When the diagnostic process involves X-rays, you’ll likely use either 73100 (Radiologic examination, wrist; 2 views) or 73110 (… complete, minimum of 3 views).

Look to This Trio for Tendon Repair

Once the provider decides that a wrist/forearm tendon repair is necessary, you’ll have three codes to choose from for the service:

• 25260 (Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle)
• 25263 (… secondary, single, each tendon or muscle)
• 25265 (… secondary, with free graft (includes obtaining graft), each tendon or muscle)

Check out a rundown of the repair codes you’ll use for these surgeries, courtesy of Wayne Conway, CPC, CGSC, COSC, physician coder II at WakeMed Physicians Practice in Raleigh, North Carolina:

“Code 25260 would be used for a primary repair of a flexor tendon in the forearm or wrist areas. Often tendon injuries are from traumatic experiences such as accidental lacerations, automobile accidents or falls on an outstretched hand.

“If a secondary repair is needed, code 25263 would be used and code 25265 would be used if a graft is utilized. Also, remember the code description reads ‘each tendon,’ so be sure to bill correct units to reflect the number of tendons repaired if more than one tendon is repaired,” explains Conway.

There is also a chance the orthopedist will conduct similar repairs for the extensor tendons. When this occurs, choose a code from the 25270 (Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle) through 25275 (Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)) code set.