By Daniel J. Nagle, MD
Chair, ASSH CPT/RUC Committee
January of this year saw the introduction of three new joint manipulation codes. The codes, the rationale for their existence and their expected use are listed below.
It has come to my attention that there is some confusion regarding the use of these codes. The intent of these codes is to allow surgeons to report the work associated with the manipulation of joints when such manipulation is done either as a stand alone procedure, or in conjunction with another procedure(s) in which joint manipulation is not an integral component. The -59 modifier should be appended to the manipulation code when used in the latter situation.
Clearly the work of manipulating a joint in conjunction with a tenolysis, tenotomy, tenosynovectomy, palmar fasciectomy, capsulotomy or other procedures performed to increase the range of motion of a digit, wrist or elbow, would be included in the work of the primary procedure (tenolysis, tenotomy, tenosynovectomy, palmar fasciectomy, capsulotomy etc.).
The Administar Corporation, as a part of the continuing Correct Coding Initiative (CCI), has provided CMS (Center for Medicare and Medicaid Services) with a list of procedures that they believe should not be simultaneously coded with 24300, 25259 or 26340. The list of these “code pairs” is included in this article for your reference. Dr. Mitchell E. Nahra and his ASSH CCI Subcommittee have reviewed these code pairs and believe them to be reasonable.
Example: A 30 year old male presents with flexion contractures of the PIP joints of the right index and long fingers. A palmar capsular release and manipulation are carried out on the index finger PIP joint and the long finger PIP joint undergoes a closed manipulation.
Coding
26525 - Capsulectomy of capsulotomy; interphalangeal joint, each joint
26340-59 - Manipulation, finger joint, under anesthesia, each joint
OR
26525 - Capsulectomy of capsulotomy; interphalangeal joint, each joint
26340-59-51* - Manipulation, finger joint, under anesthesia, each joint
*Some insurers require the use of both the -59 and -51 modifiers.
Please note that in this example the manipulation of the index finger PIP joint is not coded as it is considered an integral part of the work described by 26525.
I hope this clarifies the use of these codes. If you have any further questions please let us know.
New Manipulation Codes
24300 Manipulation, elbow, under anesthesia
(For application of external fixation, see 20690 or 20692)
Rationale: This code, as well as the codes for manipulation of the wrist and finger joint, completes the manipulation code series which previously included the ankle, knee, hip and shoulder but excluded the upper extremity below the shoulder.
Service description: The elbow is gently taken through a full range of motion from the maximum amount of flexion to the maximum amount of extension allowable. Care is taken to avoid applying excessive force. The manipulation of the joint is repeated as needed until the maximum range of motion is achieved
Remark: The manipulation is to be done under general or regional anesthesia. The administration of the anesthetic would be coded separately. The manipulation of the elbow inherent in the open treatment of an elbow contracture (24149) is included in the work of the open contracture release and 24300 should not be used in addition to 24149.
25259 Manipulation, wrist, under anesthesia
(For application of external fixation, see 20690 or 20692)
Service description: The wrist is gently taken through a full range of motion from the maximum amount of flexion to the maximum amount of extension allowable. Care is taken to avoid applying excessive force. The manipulation of the joint is repeated as needed until the maximum range of motion is achieved.
Remark: The manipulation is to be done under anesthesia. The administration of the anesthetic would be coded separately.
26340 Manipulation, finger joint, under anesthesia, each joint
(For application of external fixation, see 20690 or 20692)
Service description: The finger joint is gently taken through a full range of motion from the maximum amount of flexion to the maximum amount of extension allowable. Care is taken to avoid applying excessive force. The manipulation of the joint is repeated as needed until the maximum range of motion is achieved.
Remark: The manipulation is to be done under anesthesia. The administration of a local anesthetic would be included in the work described by this procedure. Anesthesia other than local anesthesia should be coded separately. The manipulation of a finger joint in the course of a closed reduction or open procedure on or about the joint would be considered an integral part of such procedures and would not be coded with 26340.
CCI Edits for 24300: 25259, 26340