Summary & Overview
CPT 25119: Extensor Tendon Sheath Synovectomy with Distal Ulna Excision
CPT code 25119 represents a focused wrist surgery combining synovectomy of the extensor tendon sheath within a specific compartment and excision of a portion of the distal ulna. This procedure is relevant nationally for orthopedic and hand surgery practices managing inflammatory or degenerative tendon sheath disease, traumatic injuries, and ulnar-sided wrist pathology that may require both soft-tissue and limited bony work. Coverage and payment for this code affect surgical workflow, facility utilization, and cost of care for wrist procedures.
Key payers included in the discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses how the code is defined clinically and operationally and what stakeholders can expect when this CPT code is billed in ambulatory surgery or hospital outpatient settings.
Readers will find a concise clinical and billing orientation to CPT code 25119, including expected service settings, typical clinical indications, and how this code fits into hand and wrist procedure coding. The publication also outlines where to look for benchmarks and policy updates relevant to surgical codes, and highlights common billing considerations and documentation points necessary to support the described surgical components.
Billing Code Overview
CPT code 25119 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 defined wrist compartment. The procedure also includes excision of a portion of the distal ulna near the wrist.
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Service type: Surgical debridement and partial bony excision of the wrist involving the extensor tendon sheath and distal ulna
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Typical site of service: Outpatient ambulatory surgery center or hospital operating room for wrist surgery
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–65-year-old manual laborer or middle-aged adult presenting with dorsal wrist pain, localized swelling, and crepitus over the distal radioulnar joint and the extensor tendon compartments. Symptoms often include pain with wrist extension and forearm rotation, reduced grip strength, and activity-related catching or triggering of the extensor tendons. Conservative care such as splinting, nonsteroidal anti-inflammatory drugs, corticosteroid injection, and activity modification has failed.
Preoperative evaluation includes focused hand and wrist examination, imaging (wrist radiographs to assess the distal ulna and degenerative changes; ultrasound or MRI to evaluate tendon sheath synovitis), and discussion of risks and benefits. In the operating room or procedure suite, the surgeon makes a limited incision over the involved extensor compartment, excises inflamed synovial tissue from the extensor tendon sheath, and performs a distal ulna resection (partial ulnar head or wafer resection) as indicated to address impingement or ulnocarpal abutment. Typical workflow includes regional or general anesthesia, sterile prep, operative exposure, synovectomy, distal ulna excision, hemostasis, layered closure, and application of a dressing and splint. Postoperative care includes short-term immobilization, wound care, pain control, and early supervised hand therapy to restore range of motion and function.
Typical site of service: Ambulatory surgery center or hospital outpatient surgical department. Service type: Hand/wrist surgical procedure (open synovectomy with partial distal ulna excision).
Coding Specifications
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