Coding Guidance for Tendon Repairs
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Editor's Note: This article by Paul Cadorette, director of education for mdStrategies, originally appeared in The Coding Advocate, mdStrategies free monthly newsletter. Sign-up to receive this newsletter by clicking here.
Although nothing has changed on the surface regarding tendon repair codes found in the CPT manual, behind the scenes AAOS (American Academy of Orthopaedic Surgeons) has made significant revisions to the 2011 "Complete Global Service Data Guide". The information presented in this article is an overview of some of these changes and it is still recommended that any specific questions be addressed by carrier representatives or your individual carrier policies.
The AAOS considers the following services components of a tendon repair;
- Suture removal
- Incision(s) required to expose tendon ends
- Tendon retrieval and/or preparation of the tendon ends
- Repair of the extensor retinaculum
For example, the physician incises the extensor retinaculum to expose an extensor tendon compartment which contains the lacerated tendon. This is done as part of the approach for a tendon repair and once the tendon repair is completed the physician finds that the patient has instability of the dorsal tendon compartment because the extensor retinaculum was surgically incised. The physician now performs an extensor retinacular repair to stabilize the tendon compartment. This does not represent a separate diagnosis/procedure since the physician originally incised the retinaculum, so the coder should not report an extensor retinaculum repair/reconstruction for this service.
No longer listed in the AAOS guide is a tenosynovectomy or tenolysis of the lacerated tendon but that doesn't necessarily mean you will receive additional reimbursement for reporting these services. I have been involved in case reviews where the reviewer cited, word for word, information that's contained in the Global Service Data Guide and when utilizing these guidelines it is possible that these services may get paid. Just remember that in most instances a tenosynovectomy or tenolysis are going to bundle into the tendon repair when a carrier is following Medicare CCI edits.
What it all comes down to is knowing which guidelines the carrier is following and being able to maximize reimbursement based on correct coding principles.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
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