Wiki Lysis adhesions MP Joint

[orthopaedic01]

Good morning! Doctor had previously done ORIF metacarpal Fx. Patient was having difficulty with range of motion in the months following Sx. The doctor then removed the hardware and performed lysis of adhesions to the MP joint. "Dissection continued proximally and around the dorsal capsule, there appeared to be extensive scar tissue. This was debrided and once it was, the MP joint could now fully flex past 90 degrees." I am thinking a synovectomy code would be appropriate in this case. However, the only one for the metcarpalphalangeal joint that I can find is 26135, which I don't feel is appropriate in this case. Any thoughts?

 

[coderguy1939]

This is from an AAOS Bulletin:

Hardware removal

Q: The patient had a bimalleolar ORIF and, for whatever reason, a year or two later the physician removes the hardware. There are two plates and eight screws (four screws in each plate). Do you report:

• 20680x10 for the two plates and eight screws?

• 20680 just once because it is considered one internal device that was placed?

• 20680x2 because you made two incisions to remove?

A: Based on a discussion by the AAOS ICD-9 and CPT Coding Committee, removal of hardware used for a specific fracture type—regardless of the number of screws, plates, rods or incisions—would only be coded once. If there was an extraordinary of work involved (e.g., bone-buried screws, exceptional scar), then modifier -22 would be added with the usual accompanying note.

Per this description, the lysis of adhesions might warrant attaching Modifier 22 to 20680. I don't see synovitis anywhere in your original post, so I wouldn't consider 26135.

Any other opinions on this?

 

[mbort]

I agree with David