Answer Coding Help

TSTANLEY

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How would you code CMC arthroplasty w/ ligament reconstruction and tendon interposition ?
 

Orthocoderpgu

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I have read hundreds of these and never seen a ligament repair performed with this procedure, but that's not saying it can't happen. This has two codes. Code 25447 coupled with either 25310 or 26480 depending on where the tendon transfer is performed from.
 

TSTANLEY

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I have read hundreds of these and never seen a ligament repair performed with this procedure, but that's not saying it can't happen. This has two codes. Code 25447 coupled with either 25310 or 26480 depending on where the tendon transfer is performed from.
thank you
 

Orthocoderpgu

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I'm getting a headache from reading this. The doctor exposes the trapezium, but never documents that it was removed or the instrumentation used to remove it. Removing the trapezium would be 25447. Here's where things are a bit fuzzy. Normally the FDR tendon would be cut in the forearm and pulled to the space where the trapezium was, rolled up and held in place by a suture. As documented, the FDR was only cut once, and it was pulled into the hole where the trapezium was so that would be code 25312. I'm not sure why the doc thinks a "reconstruction" was performed but his wording is also confusing as well. I'm really confused with the "I pulled it out into the distal incision". He could have performed that if the tendon was cut distally, making this a free graft which changes the coding. But going by what was documented, only one tenotomy was performed. Then on the flip side the doc removed a ganglion 25111. To me the wording of this is confusing.
 
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