Wiki 25447 vs 25448

[jdibble]

I have a doctor who is doing a Carpometacarpal Arthroplasty with APL tendon transfer. He wants to bill 25447 with 26480. With the new code, 25448, I understand that 25447 and 26480 cannot be billed together and if a tendon transfer is done, 25448 should be billed. However, he is explaining that "a suture suspensionplasty is where a suture is passed between the APL and FCR tendon and in that surgery the APL tendon is not transected or transferred". He says in his surgery, the APL tendon was transected proximally and then transferred to the FCR tendon. Descriptions on Codify of both procedures do not mention which tendons are transferred where, and 25447 does not include a tendon transfer but does include an interpostion (not sure what the difference is).

Of course I am confused on what he is trying to say, but I am assuming he is saying he did not do a suspension, but he did do a tendon transfer. What would be the appropriate code for this procedure?

Thanks,
Jodi

 

[NRaizman]

He cannot -ever-, now or in the future, bill 25447 and 26480 together. It is not a possibility. It is expressly prohibited by the CPT Manual. No modifier will get you past it. Period, end of story.

The case you describe above is 25448 alone.
You can refer the surgeon to me if needed.

 

[jdibble]

He cannot -ever-, now or in the future, bill 25447 and 26480 together. It is not a possibility. It is expressly prohibited by the CPT Manual. No modifier will get you past it. Period, end of story.

The case you describe above is 25448 alone.
You can refer the surgeon to me if needed.

Thank you!

 

[anagel123]

My surgeons are asking to code 25448, 25118, 26445 together. Is this possible if the synovectomies are in the same as the CMC arthroplasty; even if using a separate incision closer to the wrist?

 

[NRaizman]

My surgeons are asking to code 25448, 25118, 26445 together. Is this possible if the synovectomies are in the same as the CMC arthroplasty; even if using a separate incision closer to the wrist?

What's the indication? How is it being described? These codes are for tenolysis, not synovectomy.

Please send an operative report.

In a dozen years and a few hundred CMC arthroplasties, I have never once done an extensor tenolysis in association with a CMC arthroplasty, so I would be -extremely- skeptical unless there was clear documentation of completely separate pathology.