CPT Coding for Multiple Tenotomies
For a patient undergoing right thumb abductor, flexor carpi ulnaris (FCU), and pronator teres tenotomies, the appropriate CPT code is 26060 (Tenotomy, percutaneous, single, each digit, other than trigger finger) for the thumb procedure, and 25290 (Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single, each tendon) for each of the FCU and pronator teres procedures.
Coding Structure
The coding approach depends on whether these are percutaneous or open procedures:
For Percutaneous Tenotomies:
- CPT 26060 for the thumb abductor tenotomy (digital procedure)
- CPT 28010 or 28232 may apply if these are foot/toe procedures (though your question specifies hand/wrist)
- For forearm tendons (FCU and pronator teres): CPT 25290 for each tendon if performed open
For Open Tenotomies:
- CPT 26060 remains appropriate for digital procedures
- CPT 25290 for each forearm tendon (FCU and pronator teres) - this code specifically states "single, each tendon"
Key Coding Principles
Bill each tendon separately when multiple tenotomies are performed. The CPT guidelines specify "each tendon" or "single" in the code descriptors, indicating that:
- The thumb abductor tenotomy is coded once
- The FCU tenotomy is coded separately
- The pronator teres tenotomy is coded separately
Modifier Considerations:
- Use modifier -59 (Distinct Procedural Service) or -XS (Separate Structure) to indicate these are separate anatomical structures
- Use modifier -RT to specify right side
- If performed percutaneously versus open, ensure code selection matches the surgical approach
Clinical Context from Evidence
While the provided evidence focuses primarily on flexor tenotomy for diabetic foot ulcer prevention 1, the coding principles remain consistent across anatomical locations. The evidence discusses digital flexor tendon tenotomy as an outpatient procedure 1, which supports the use of percutaneous codes when applicable.
Common Pitfalls to Avoid:
- Don't bundle all three procedures under a single code - each tendon tenotomy should be coded separately
- Verify the surgical approach (percutaneous vs. open) as this changes the CPT code selection
- Don't confuse with trigger finger release (CPT 26055) - these are distinct procedures
- Ensure proper documentation of each individual tenotomy to support separate billing 2
The increased complexity and time associated with multiple procedures should be reflected in appropriate coding 3, making it essential to code each tenotomy individually rather than using a bundled approach.