LaurenBrooke
Contributor
Provider performed lengthening of the extensor retinaculum overlying the fourth dorsal compartment following excision of extensor tendon intrasubstance ganglion cyst from dorsal hand.
Although the cyst had been addressed, it was felt appropriate to slightly lengthen the extensor retinaculum overlying the fourth compartment to diminish any risk of tendon catching during finger range of motion. The extensor retinaculum over the fourth compartment had been opened in a step-cut manner to allow for it to be closed in a lengthened position. The extensor retinaculum was closed in a slightly lengthened position using interrupted 3-0 Vicryl sutures. The extensor pollicis longus tendon had been retrieved from the third dorsal compartment and transposed dorsal to the retinaculum. The EPL tendon was left dorsal to the retinaculum at the time of closure.
Are we able to bill separately for the retinaculum lengthening? I understand that CPT 25270 (Repair tendon or muscle, extensor) includes excising a portion of the carpal ligament to help the tendons from getting stuck as they heal, but a tendon repair is not being done. There is also CPT 25116 that includes retinaculum transposition but this code would require a radical excision of bursa, synovia of wrist, or forearm tendon sheaths which, is not being done. Regardless, neither of these codes capture the lengthening being done.
Operations Performed:
1) Excision finger extensor tendon intrasubstance ganglion cyst dorsal hand -25110
2) Posterior interosseous neurectomy (I realize I did not go into detail about this above) -64772
3) Lengthening of the extensor retinaculum overlying the fourth dorsal compartment -?
4) Dorsal transposition of the extensor pollicis longus tendon superficial to the extensor retinaculum - I do not believe this should be billed separately as the EPL was retrieved and retracted radial to allow wide exposure of the fourth compartment tendons so they could be retracted ulnarly to expose the floor of the fourth compartment where the terminal branch of the posterior interosseous nerve was anesthetized and excised to address any wrist pain symptoms
If anyone is a hand expert and are able to offer some insight on extensor retinaculum lengthening, please do! I am not sure if it is something that will be able to be captured separately, but any help is great!
Although the cyst had been addressed, it was felt appropriate to slightly lengthen the extensor retinaculum overlying the fourth compartment to diminish any risk of tendon catching during finger range of motion. The extensor retinaculum over the fourth compartment had been opened in a step-cut manner to allow for it to be closed in a lengthened position. The extensor retinaculum was closed in a slightly lengthened position using interrupted 3-0 Vicryl sutures. The extensor pollicis longus tendon had been retrieved from the third dorsal compartment and transposed dorsal to the retinaculum. The EPL tendon was left dorsal to the retinaculum at the time of closure.
Are we able to bill separately for the retinaculum lengthening? I understand that CPT 25270 (Repair tendon or muscle, extensor) includes excising a portion of the carpal ligament to help the tendons from getting stuck as they heal, but a tendon repair is not being done. There is also CPT 25116 that includes retinaculum transposition but this code would require a radical excision of bursa, synovia of wrist, or forearm tendon sheaths which, is not being done. Regardless, neither of these codes capture the lengthening being done.
Operations Performed:
1) Excision finger extensor tendon intrasubstance ganglion cyst dorsal hand -25110
2) Posterior interosseous neurectomy (I realize I did not go into detail about this above) -64772
3) Lengthening of the extensor retinaculum overlying the fourth dorsal compartment -?
4) Dorsal transposition of the extensor pollicis longus tendon superficial to the extensor retinaculum - I do not believe this should be billed separately as the EPL was retrieved and retracted radial to allow wide exposure of the fourth compartment tendons so they could be retracted ulnarly to expose the floor of the fourth compartment where the terminal branch of the posterior interosseous nerve was anesthetized and excised to address any wrist pain symptoms
If anyone is a hand expert and are able to offer some insight on extensor retinaculum lengthening, please do! I am not sure if it is something that will be able to be captured separately, but any help is great!