April 4, 2022 | Jean Stoner
We recently presented a CPT-4 coding challenge with an example of a trigger finger release. We’ll repeat the example and provide the answer.
What CPT-4 code(s) should be assigned for this procedure?
PREOPERATIVE DIAGNOSES:
PROCEDURES PERFORMED:
DESCRIPTION OF PROCEDURE: The patient was identified in preoperative holding area. Surgical site marked. Brought to the OR table, positioned supine. Tourniquet applied on proximal arm. A peripheral nerve block given consisting of 5 cc of 1% lidocaine with epinephrine and 0.25% Marcaine plain as a digital block for pain control and vasoconstriction. He was prepped and draped in usual sterile fashion. A time-out performed.
Preoperative antibiotics given. Extremity exsanguinated using Esmarch bandage. Tourniquet inflated to 220 mmHg. Transverse incision made in line with ring finger. Incision taken through subcutaneous tissues and palmar fascia. The digital bundles on both sides were identified and protected throughout the case. A1 pulley released under direct vision. Inflamed flexor tenosynovium excised sharply with scissors. The finger was taken through range of motion and found not to trigger. Hemostasis was obtained. Wound was washed out. Incision was closed with 4 - 0 nylon. Sterile dressing applied.
ANSWER:
26055-F3 - Tendon sheath incision (e.g., for trigger finger)
You may wonder, “why isn’t the peripheral nerve block coded using 64450?” Nerve blocks are a necessary part of many surgical procedures for a total loss of feeling if needed for surgery and are often also used for post-operative pain relief, but if the block is not documented as being for post-operative pain management, then it is assumed to only be used for the surgery and therefore included in the surgical package and not coded separately. Providers must remember to be very clear to document that the block is for post-operative pain management, otherwise coders can’t assume that is the case and should not code the nerve block.
Here are some tips to help guide your coding for nerve blocks:
Operating providers
Example 1: Physician CCI edits for 26055 show 64450 as being a component of 26055, and it is allowed to be bypassed with a modifier if appropriate (1 status)
26055 - Tendon sheath incision (e.g., for trigger finger)
64450 - Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch
Example 2: Physician CCI edits for 23412 show 64415 as being a component of 23412, and it is NOT allowed to be bypassed with a modifier (0 status)
23412 - Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic
64415 - Injection(s), anesthetic agent(s) and/or steroid; brachial plexus
Anesthesiologists
Jean Stoner, CPC, product owner for computer-assisted coding (CAC) content for outpatient and professional services for 3M Health Information Systems.
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