Orthopedic Coding Alert

Question: In a patient with left wrist pisiform-triquetral arthritis (pisotriquetral arthritis) with bone on bone changes between the pisiform and triquetrum, our surgeon did the following procedures:

New York Subscriber

Answer: Decompression of the Guyon's canal is done to relieve the pressure on the ulnar nerve which passes through the canal in the wrist. The compression of the ulnar nerve in this canal may present with motor and/or sensory symptoms. You report code 64719 (Neuroplasty and/or transposition; ulnar nerve at wrist) for the Guyon canal decompression.

For the excision of the pisiform bone in the left wrist, you report code 25210 (Carpectomy; 1 bone) as the pisiform is one of the carpal bones in the wrist. Carpectomy implies the excision of one or more of the carpal (wrist bones).

You may also report the diagnosis codes 716.94 (Unspecified arthropathy involving hand) for the pisiform-triquetral arthritis.