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Wiki Capsulectomy/Tenolysis

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lpreidis

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Looking for clarification, can an Extensor tenolysis 26445 be billed with Capsulectomy 26525 same finger or is the Capsulectomy included in the tenolysis. we keep getting denials and am unsure how to appeal if we even can... thank you any help would be appreciated.
 
Could you provide a redacted op note? Capsulectomy is not performed frequently. Capsulotomy is performed all the time. Is the capsule being opened so the doc can get to the tendon? If so, that would be your answer. If the doc has to open the joint capsule to get to the tendon, it would be bundled. My other question is, what diagnosis are you linking to the capsulectomy? There would have to be a diagnosis to support the procedure.
 
Could you provide a redacted op note? Capsulectomy is not performed frequently. Capsulotomy is performed all the time. Is the capsule being opened so the doc can get to the tendon? If so, that would be your answer. If the doc has to open the joint capsule to get to the tendon, it would be bundled. My other question is, what diagnosis are you linking to the capsulectomy? There would have to be a diagnosis to support the procedure.
Dx: Contracture of the finger

DESCRIPTION OF THE PROCEDURE: Patient was taken to the operating room and placed on the operating table in supine position. 1% lidocaine mixed with sodium bicarbonate in a ratio of 10:1 injected as a digital block for the left middle finger. This was done under sterile conditions and she tolerated that well. A pneumatic tourniquet over Webril was placed over the left proximal arm. The left upper extremity was prepped and draped in usual sterile fashion. The extremity was elevated and tourniquet was inflated to 250 mmHg. A midline longitudinal incision was made over the ulnar aspect of the PIP joint of the left middle finger. The incision was carried down through the dermis and subcutaneous tissue, down to the ulnar collateral ligament of PIP joint and capsule. The ulnar collateral ligament was incised. A capsulectomy was performed. The extensor tendon was adhesed. Extensor tenolysis was performed. Palmarly, we continued the dissection down to the flexor tendons, which also had adhesions, for which a flexor tenolysis of the FDS and FDP tendons was performed. We did a closed manipulation of the DIP joint and MP joint of the left middle finger. We were able to obtain 0 to 90 degrees of motion of the PIP joint, 0 to 65 degrees of the DIP joint motion, and 0 to 95 degrees of MP joint motion of the left middle finger. She was able to make a full fist. We brought the drapes down, showed her the improvement she had, and she appeared to be quite pleased as she was able to make a full fist. She had essentially full flexion of the left middle finger and full extension actively.
 
It looks like the capsulectomy was done to "get to the surgical field". So this would be included with the tenolysis of the FDS & FDP tendons. Capsulotomy as a treatment is usually performed to give motion back to a joint. But most of the time the capsule is opened so the doc can get where they need to go.
 
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