Trigger finger release CPT code 26055 can be reported for stenosing tenosynovitis by incising the tendon sheath at the finger’s base.
Trigger finger issue comes to the limelight when a finger stays in a stiff bent position for some time due to swollen tendon or inflammation, narrowing of A1 pulley, or formation of nodules among the tendon.
Trigger finger problem has to be resolved by employing a well-skilled surgeon to perform such a delicate task of treating it precisely.
Trigger finger release CPT code 26055 can only be performed by a specialty surgeon. Additionally, the specialty surgeon and coder have to consider all the required CPT (Current Procedural Terminology) codes involved in this operative procedure. This is the only way to get their reimbursement as per the job done.
Trigger Finger Release CPT Code 26055 Description
The CPT 26055 describes trigger finger release. However, like all other CPT codes, the 26055 CPT code also includes inclusions.
The surgeon or the coder has to read its applications and detailed description so that nothing remains invisible from their eyes when billing for the same for the government payers (Medicare or Medicaid) or the commercial payers to get the required reimbursement.
CPT 26055 is a standard and preferable surgical procedure that revitalizes the mobility of stiff fingers caused by a Trigger Finger.
However, the finger remains contracted and pains when the patient uses those extensor tendons. Therefore, a specialty surgeon performs this surgery under local anesthesia.
A mild sedative may be introduced intravenously (IV), and local anesthesia would numb the area. Once the anesthesia takes effect on the body, the surgeon starts the course of surgery that he has already devised to relieve the patient.
The surgeon must first locate the problematic tendon sheath and create a small incision of merely ½ inch (size of an incision may vary depending on the case) on the dermal tissue, at the base of the affected finger flexion crease at the palm of a hand, to produce enough room for tendon visualization and movement.
Next, the surgeon cuts the tendon sheath (A1 pulley), which impedes mobility if swollen. The whole sectioning of the A1 pulley is compulsory to retain the mobility of the digit.
The cut is made proximal to the base of the finger flexion crease, and the tendon releases pressure. This cut preserves not only the A2 pulley but also the NV bundle.
The physician has to make sure that the finger moves smoothly and freely. After being convinced, the respective area is carefully stitched before the anaesthesia wears off.
Then, the patient should move the finger freely right after the numbness is gone. This way, the physician or the surgeon makes an all-out effort to stick to the variables outlined in their mind to treat the patient by employing the available and applicable medical amenities.
This is done for the object of, later on, getting paid by the cover company, the government payers, or the commercial payers.
Here, the physician’s task is to employ the related CPT codes required and then mention them to the coder to make the coder’s task easier and to the point.
CPT 26055 aftercare includes using a properly sanitized bandage, using a dry ice pouch for a short time, preferably 5 minutes a day, to avoid any infection, and reducing pain if caused by the stitches.
In addition, an ice patch would keep the finger and palm from being sore. Routine exercises are also recommended in most cases.
The percutaneous trigger finger release is due to the contraction of the A1 pulley because of the disturbance in the Metacarpophalangeal joint causing the shifting of NV structures dorsally.
The area is made numb, a needle is introduced into the skin and A1 pulley, tendon sheath is cut, and the finger is allowed to extend smoothly.
As there was no incision in the first place, so no stitches are required, the cut sheath would grow itself.
However, this procedure has some risk of Neurovascular damage mainly because of poor visualization, but still, this procedure has a 90% success rate.
CPT 26055 comes with its complications depending on the surgeon’s skill, including the incomplete cure, digital nerve injury, A2 pulley release with bowstringing, stiffness, vascular injury, wound maceration, and tendon tear.
The specialty surgeon must keep an eye on all the operation details, ensure that the procedure is done according to the set rules, and use all the necessary CPT codes necessary for performing this operation.
Perfect consideration is given to the codes related to the operative procedure, as this will lead to the desired amount of reimbursement in the long run.
CPT 26055 procedure is an efficient way of treating Trigger fingers as it provides a higher success rate and lesser iatrogenic neurovascular damage.
The cutoff tendon then grows back and provides the same efficient output unless there were any errors in the surgery, like nonprofessional cut by the surgeon that may damage the neurovascular bundle (NV).
CPT 26055 and CPT 26460 treatments are related but must not be mistaken as they are not precisely similar. Therefore, it is highly recommended that the physician and the coder read the code specifications correctly.
This is the only way to reach the goal of the desired amount of correct compensation at the end of the day.
CPT 26055 is a surgical procedure that may involve an incision. It is only used for trigger finger release, while CPT 26460 involves the open tenotomy, the surgical division of the extensor tendon of the hand or finger.
Billing Guidelines For CPT 26460
Tendon Sheath incision is billed depending on which service center has offered the service, whether Ambulatory Surgery Centre (ASC) or Hospital Outpatient Departments.
The billing depends on the DOS (Date of Services), the POS (Place of Services), and the services performed.
This billing method is solely based on US Medicare official announced charges of the services. In addition, the procedure performed must prove a medical necessity.
A hospital has an outpatient department that treats the outpatients who do not require a bed or an overnight stay and care. However, outpatient departments perform a broad range of services, including diagnostic tests and minor surgical procedures.
Trigger Finger Release CPT Code 26055 Reimbursement
Ambulatory Surgery Center (ASC) charges a total of $1023, including doctor fee and Facility fee per procedure and aftercare.
Out of this, the patient only has to pay $204 while US Medicare pays the other amount; the patient can undoubtedly benefit depending on the possession of the Medicare Advantage plan or supplemental insurance policy.
One must go through the guidelines issued by the American Medical Association before going ahead in this. In addition, the compensation rates may sometimes change for some commercial companies that cover medical facilities in the length and breadth of the USA.
While Hospital Outpatient departments charge an average total of $1692 per procedure, patients pay about $338 while US Medicare reimburses the other amount.
The fares can vary upon possession of a Medicare Advantage Plan or Supplemental Insurance Policy.
The costs provided are national averages and cannot be considered a final utmost word. Also, the CPT 26055 should be supported with the required medical documentation.
The cost for a mere CPT 26055 surgical procedure is $483.19 on average.
This amount does not include the physician’s fee. More than one procedure for treatment and charges may vary following that.
Your supplemental insurance Policy may cover your procedural costs. A bit of professional medical advice, diagnosis, or treatment is still advised, and this should be considered the only form of reliable information.
Modifiers For Trigger Finger Release CPT Code 26055
CPT 26055 does need some add-ups, like F modifiers to specify the location. Modifier RT or LT to identify right or left depending on where the incision is made.
For example, the CPT 26055 modifier for the right middle finger would be F7.
If the procedure is performed on one or more fingers, it shows the physician’s increased period and increased physical and mental effort. In this case, modifier 51 may be appended.
Modifier 51 is used mainly for the same procedure performed on the different sites on the same day and the same session and by the same physician.
The modifier 59 can also be appended to bypass the edits when performed with other services. As modifier 59 describes as the distinct procedural services.
Modifier 59 is still preferred to prevail the NCCI (National Correct Coding Initiative) edits.
Modifier 51 and modifier 59 are payment modifiers. Both can affect reimbursement significantly.
The ICD 10 CM codes are the codes assigned to the problem that is aimed to be treated, while CPT codes are the postoperative or during the treatment codes.
It should also be noted that using an appropriate ICD 10 CM is also mandatory with an appropriate modifier. Therefore, the wrong usage of diagnosis codes with appropriate modifiers may lead to the denial of the claim.
While using modifiers, the coder has to ensure that they consult the AMA guiding principles, latest rules and regulations, and the CPT code specifications before preparing the report for compensation.
Two examples for trigger finger release CPT code 26055 can be found below.
A 55-year-old patient was diagnosed with a Left ring Trigger Finger (F3).
Trigger finger release procedure (CPT 26055) is executed on the affected finger. First, the patient is given anesthesia, and the A1 pulley is sectioned, the incision part is stitched. Patient aftercare includes monitoring of finger movement.
ICD 10 CM code for the Left ring trigger finger is M65.342, and the coder applies this code to apply for reimbursement purposes.
All related CPT codes have to be specified to receive the expected reimbursement, along with mentioning the required details if the need and space be there to stay away from the auditing of the issue.
A 30-year-old patient has been diagnosed with a Right Middle Trigger Finger (F7).
CPT 26055 procedure is acted out on the patient, and all the necessities were met. However, the person may have acquired the problem because of extensive or heavy usage of the right hand, and inflammation may have occurred that kept the F7 in its flexor state.
M65.331 is a valid diagnosis code that can be billed with CPT 26055, in this case. ICD 10 CM (International Classification of Diseases) should be used very cautiously.
The coder must know the exact CPT codes as, without them, there are chances of losing money that the surgeon or the physician is expecting to receive from the government or the commercial payers.
It is quite probable for the coder to get in touch with the surgeon if the need is there to get the desired detail of the operation in this regard.