Wiki Closed finger joint capsulotomy

[apoland]

Hi,
I have two physicians who each performed a closed capsulotomy of a finger joint by "forcibly flexing joints all the way to 90. With some time and sustained flexion, we were able to get full flexion. There was audible and palpable crunching of scar tissue snapping during this maneuver."

They want to bill 26520-52. We looked at 26341 however there was no enzyme (xiaflex) injection, there is also 26340 however this was under local anesthesia only.

Any assistance would be greatly appreciated!

Thank you,
Autumn

 

[fish4codes]

I code for hand surgeons and although they have never done this in the office, the 26520 code clearly states "physician removes or incises the joint capsule to release the contracture and restore function, etc." so for a closed procedure this would be in appropriate. When I run this scenario through 3M it takes me to a manual therapy code based on time units, i.e. 15 minutes/1 unit with evaluation (required by MC), PT eval (low), PT modifier (no), functional G code (no) it provides codes 97140 and 97161... Good Luck, I look forward to hearing more thoughts on this...

 

[MI_CODER]

I would code this as 26340 with the appropriate finger modifier.

According to the CPT Assistant, Special 2006 Page: 2 Category:

Question:

Do the phrases "with anesthesia" or "requiring anesthesia" in CPT code descriptors preclude the reporting of anesthesia codes?

AMA Comment:

It should be noted that there are certain CPT code descriptors in the CPT codebook that include the phrases "with anesthesia" or "requiring anesthesia." These phrases indicate that the work involved in performing that procedure requires anesthesia, whether it is general anesthesia, regional anesthesia, or monitored anesthesia care. The appropriate anesthesia code is reported separately. Moderate (conscious) sedation is not an anesthesia service.

 

[KimberlySherman]

Regional anesthesia involves anesthesia of a large area of the body (in this case, a peripheral nerve block), whereas local is in the immediate area only. The Optum lay description for 26340 states that Following the induction of general anesthesia, the physician evaluates the finger. The finger is manipulated by stretching, rotation, and other maneuvers to gain the appropriate range of motion. However, I found one payer (United Healthcare commercial) that allows local anesthesia for this procedure, but they only cover the knee and shoulder. I would check the specific payer policy on manipulation under anesthesia. If the procedure is not payable, an E&M code with a small joint injection code (20600) would be feasible, if supported by the documentation.