Summary & Overview
CPT 25118: Extensor Tendon Sheath Synovectomy, Wrist Compartment
CPT code 25118 denotes a focused surgical synovectomy of the extensor tendon sheath within a wrist compartment. This code captures targeted excision of the synovial layer after incision and exposure of the extensor tendon, a procedure commonly performed for focal tenosynovitis or compartment-specific inflammatory conditions of the wrist. Nationally, accurate coding of this procedure matters for clinical documentation, appropriate payment for hand and wrist surgical services, and monitoring utilization trends for specialty surgical care.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, and standard billing considerations. The publication provides benchmarks where available, highlights relevant policy or coverage updates affecting surgical hand and wrist interventions, and summarizes common modifiers used in practice. The content is written for a national audience and is intended to help coding professionals, surgical practices, and policy analysts understand the clinical scope and billing implications of CPT code 25118 without making clinical or billing recommendations.
Billing Code Overview
CPT code 25118 describes a surgical procedure in which the provider makes an incision to expose an extensor tendon and excises the synovial layer from the extensor tendon sheath within a specific limited area of the wrist known as a compartment.
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Service type: Surgical debridement/excision of synovial tissue of the extensor tendon sheath in a wrist compartment
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Typical site of service: Ambulatory surgical center or hospital outpatient department (procedure performed at the wrist)
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 52-year-old right-hand-dominant office worker presents with a several-month history of dorsal radial wrist pain, swelling, and painful wrist extension exacerbated by repetitive thumb and wrist movements. Examination reveals focal tenderness over the first extensor compartment with crepitus and reduced function consistent with stenosing tenosynovitis (De Quervain disease) refractory to conservative care (splinting, NSAIDs, corticosteroid injection). Imaging (ultrasound or radiographs) excludes fracture and shows tenosynovial hypertrophy localized to the extensor tendon sheath. The surgical workflow for 25118 includes preoperative consent and localization of the involved extensor compartment, regional or local anesthesia with monitored sedation, a small longitudinal incision to expose the extensor tendon, excision of the synovial layer from the extensor tendon sheath within the affected compartment, hemostasis, and layered wound closure. Postoperative care includes dressing application, brief immobilization in a splint, discharge with wound care instructions, and outpatient follow-up for suture removal and hand therapy as indicated. Typical site of service is an ambulatory surgery center or hospital outpatient department; the service type is a minor hand/wrist surgical procedure performed by an orthopedic hand surgeon, plastic surgeon with hand specialty, or a hand surgeon credentialed in a general surgery or orthopedic practice.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |