Orthopedic Coding Alert

... and you may not even know it

The next time your surgeon documents a trigger finger release, double-check your code choice to make sure you report 26055, not the tenosynovectomy code 26145 or the tenolysis code 26440. What's the difference? It could be about $460 more in revenue than you deserve.

Know the Difference Between 3 Codes

Hand surgeons who treat trigger finger (727.03) often start the patient's treatment with non-invasive services, such as trigger finger injections (20550, Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar -fascia-]). But when the patient's symptoms don't improve, surgeons may choose to perform a trigger finger release.

The problem: Some coders review trigger finger release documentation and overlook the appropriate code, 26055 (Tendon sheath incision [e.g., for trigger finger]). Some coders say that they may instead look to one of two other codes:

- 26145--Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon
- 26440--Tenolysis, flexor tendon; palm OR finger, each tendon.

-These codes should only be used in very specific, relatively rare instances,- says Carl Weiss, MD, a hand surgeon at OrthoMemphis PC in Memphis, Tenn. -These codes really have no place in the treatment of straightforward trigger finger.-

And if you planned to report both 26055 and 26145, think twice. -Indeed, under the global-service guidelines, tenosynovectomy is included in trigger finger release and it would be considered unbundling to bill both,- Weiss says. And both National Correct Coding Initiative (NCCI) and American Academy of Orthopaedic Surgeons (AAOS) guidelines include tenosynovectomy as a component of 26055.

Diagnosis coding clues: If you can't determine which code is appropriate, the patient's diagnosis may give you a hint. Surgeons usually perform the trigger finger release described by 26055 for patients with trigger finger. But -in patients with rheumatoid arthritis, you are supposed to perform a tenosynovectomy instead of a trigger finger release, to help prevent ulnar drift,- Weiss says. Therefore, if you see documentation of tenosynovitis due to rheumatoid arthritis (714.0 and 727.01), there's a safe bet you shouldn't be reporting 26055.

Use Modifiers for Multiple Trigger Finger Releases

If your hand surgeon treats multiple trigger fingers during the same operative session, you should append the applicable finger modifiers (FA-F9) to the CPT code. -You should only use modifier 59 (Distinct procedural service) if you absolutely have to,- says Annette Grady, CPC, CPC-H, director of educational services with Coding Metrix. -The -F- modifier should not require the additional use of modifier 59.-

Therefore, if your surgeon performs trigger finger releases on the thumb and second finger of the right hand, you should report 26055-F5 and 26055-F6.

If your insurer does not accept the finger modifiers, you should revert to modifier 59 for the second line item of 26055. Unfortunately, even if you reported the incorrect code due to a beginner's mistake, the insurer could see it another way. When you report a higher-paying code than what the surgery warrants, you-re playing with fire.

The Medicare Physician Fee Schedule allows about $268 in nonfacility pay (not adjusted for geographic differences) for 26055. But Medicare pays $294 for 26145 and a whopping $729 for 26440. So payers--and the OIG--may see your miscoding as a way to game the system and collect more than you should if you bill incorrectly for trigger finger release services.

And if you find that you-re coding improperly because you lack the anatomy knowledge to select the right codes after reading the surgeon's op report, check out our article -Hand Surgery Cheat Sheet Can Lead You to the Right Codes- next article.