26440

[laylaykali]

I've been getting in trouble for coding laterality incorrectly am I right with the below surgical note that I have coded as:
26440-F5
26440-F8,59
26440-F9, 59

With DX Codes M67.144, M64.841, S66.194D(A?), S66.196D(A?), S66.091D9A?)


I began at the small finger. A Bruner type incision was utilized incorporating his previous scar
extending over the middle phalanx and proximal phalanx and just proximal to the MP flexion
crease. Careful dissection was undertaken to protect the neurovascular bundles radially and
ulnarly. The flexor tendon was identified and significantly scarred and stuck over the proximal
phalanx region. This was meticulously freed up with a combination of knife as well as the
tenolysis knife instruments to carefully free it up and allow motion within the finger. After this
had been performed he underwent active range of motion of the finger which was significantly
improved active range of motion but slightly lacking being able to touch his palm fully with his
finger. We blocking he had near full motion of the DIP joint.
Attention was then turned to the ring finger, and a Bruner incision was made over the ring finger
extending over the MP flexion crease proximally and distally. Dissection was continued through
the skin and subcutaneous tissue with scar tissue encountered and the digital neurovascular
bundles protected. The flexor tendon was scarred into place but more proximal on this finger
than had been on the small finger. It was again extensively scarred. This was then freed up and
mobilized with curved iris scissors as well as a 15 blade and utilizing tenolysis knife instruments.
After this had been completed, he had similar range of motion as the small finger, but it was
slightly lacking in terminal flexion at the palm but significantly improved from preoperatively
and the flexor tendon had good excursion. I then turned my attention to the thumb and his previous scar here was utilized in a Bruner
fashion proximally and distally. Dissection was continued down to the level of the flexor tendon,
and the digital neurovascular bundles were protected. The thumb flexor tendon was scarred more
distally to the level of the IP joint and required careful tenolysis with the tenolysis knives as well
as a 15 blade and curved iris scissors. After mobilization with blocking, he had good motion with
flexion of the thumb IP joint and then composite motion had significantly improved flexion of
the thumb. He was able to visualize all of this
range of motion to reinforce the necessity of
maintaining this with therapy postoperatively.

 

[Orthocoderpgu]

I've been getting in trouble for coding laterality incorrectly am I right with the below surgical note that I have coded as:
26440-F5
26440-F8,59
26440-F9, 59

With DX Codes M67.144, M64.841, S66.194D(A?), S66.196D(A?), S66.091D9A?)


I began at the small finger. A Bruner type incision was utilized incorporating his previous scar
extending over the middle phalanx and proximal phalanx and just proximal to the MP flexion
crease. Careful dissection was undertaken to protect the neurovascular bundles radially and
ulnarly. The flexor tendon was identified and significantly scarred and stuck over the proximal
phalanx region. This was meticulously freed up with a combination of knife as well as the
tenolysis knife instruments to carefully free it up and allow motion within the finger. After this
had been performed he underwent active range of motion of the finger which was significantly
improved active range of motion but slightly lacking being able to touch his palm fully with his
finger. We blocking he had near full motion of the DIP joint.
Attention was then turned to the ring finger, and a Bruner incision was made over the ring finger
extending over the MP flexion crease proximally and distally. Dissection was continued through
the skin and subcutaneous tissue with scar tissue encountered and the digital neurovascular
bundles protected. The flexor tendon was scarred into place but more proximal on this finger
than had been on the small finger. It was again extensively scarred. This was then freed up and
mobilized with curved iris scissors as well as a 15 blade and utilizing tenolysis knife instruments.
After this had been completed, he had similar range of motion as the small finger, but it was
slightly lacking in terminal flexion at the palm but significantly improved from preoperatively
and the flexor tendon had good excursion. I then turned my attention to the thumb and his previous scar here was utilized in a Bruner
fashion proximally and distally. Dissection was continued down to the level of the flexor tendon,
and the digital neurovascular bundles were protected. The thumb flexor tendon was scarred more
distally to the level of the IP joint and required careful tenolysis with the tenolysis knives as well
as a 15 blade and curved iris scissors. After mobilization with blocking, he had good motion with
flexion of the thumb IP joint and then composite motion had significantly improved flexion of
the thumb. He was able to visualize all of this
range of motion to reinforce the necessity of
maintaining this with therapy postoperatively.

Who is telling you that you are doing it wrong? I have not read the note but F modifiers would be preferred in this situation rather than -RT.

 

[laylaykali]

Who is telling you that you are doing it wrong? I have not read the note but F modifiers would be preferred in this situation rather than -RT.

I'm not saying that this note in particular I was told is wrong, just apparently for a lot of Ortho codes for hand procedures that I've coded with F modifiers the insurance is denying because they want LT/RT and so now I'm second guessing myself on a lot of things. My biggest question here is, is the 59 modifier correct?

 

[NRaizman]

No, you do not need a -59 modifier. You need a -51 modifier.

Because the NCCI MUE for 26440 is 6, you should be able to code 26440 with a -51 modifier for multiple procedures as long as you use the correct finger modifiers to differentiate.
-59 would be used -only- to bypass an NCCI PTP edit or an MUE edit, and that would only be possible with a private payor, as it cannot be bypassed in a Medicare/Medicaid patient.