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Code This!

Scenario Week of July 02, 2014:
View Current Scenario

Assign the appropriate ICD-9-CM diagnosis code(s) and CPT procedure code(s) for the following scenario.

Diagnosis: Trigger finger, left third finger, secondary to primary chronic gout of the left hand

Procedure performed: Left third trigger finger release

Description of procedure: A 72-year-old female patient presents for trigger finger repair of the left third finger. Informed consent was obtained and risks and benefits were again explained to patient. The patient was taken to the procedure room where she was placed on the operating table in the supine position. Monitored anesthesia sedation was administered, and an appropriate level of Bier block anesthesia was provided. A tourniquet was applied to the left upper extremity. The left hand and forearm were then prepped and draped in the routine sterile fashion. The correct site was once again verified prior to making an incision.

An incision was made over the A1 pulley of the third digit and carried down via dissection to the pulley. Retractors were placed on both the radial and ulnar sides of the pulley, and it was incised sharply from proximal to distal under direct visualization. The tendon then had full range of motion, and there was a complete release of the pulley. Irrigation was performed, and interrupted nylon sutures were placed in the skin. Sterile dressings were applied. The patient was then transferred to the recovery room in good condition.

Please assign the correct ICD-9-CM and CPT codes for the procedure above.


ANSWERS

Codes and Rationale

ICD-9-CM Codes
727.03 Trigger finger, acquired
274.02 Arthritis associated with gout, chronic

CPT Code
26055 Tendon sheath incision (eg, for trigger finger)

Locate the appropriate code for this condition in the ICD-9-CM alphabetical index under “Trigger finger (acquired)” which references code 727.03. Next, the code for the chronic gouty arthritis must also be reported. Locate this code in the alphabetic index under the main term “Arthropathy” and the subterms “gouty” and “chronic (without mention of tophus (tophi)” which references code 274.02. Verify both codes in the tabular section.

Trigger finger may result from overuse or another medical condition. In this case, the patient’s chronic gout has been identified as the cause of her trigger finger. The trigger finger is reported first as that is the condition chiefly responsible for the visit. Per the official ICD-9-CM Diagnostic Coding and Reporting Guidelines for Outpatient Services, section IV, A, 1, patients receiving outpatient surgery will have the condition chiefly responsible for the visit reported first, followed by codes for other conditions such as chronic conditions.

Find the correct procedure code for the trigger finger repair in the CPT index under the main term “Finger” and the subterms “Tendon,” “Sheath,” and “Incision” which reference code 26055. Verify the code in the tabular section.

 
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