Read this article for some of the greatest advice that you will find anywhere. CPT Code 41820 CPT 41820 describes excision of gingiva in each quadrant for a gingivectomy. But -in patients with rheumatoid arthritis, you are supposed to perform a tenosynovectomy instead of a trigger finger release, to help prevent ulnar drift,- Weiss says. after injection have demonstrated a success rate of 40% to 90%. Patient has F7 trigger and PIP joint contracture of same finger. Draft articles have document IDs that begin with "DA" (e.g., DA12345). Other specified dorsopathies, cervical region. Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. SHARE. 0 items. B. Overview The A1 pulley release cpt code is 26055 is for trigger finger. Does squeezing a ball help trigger finger? A 55-year-old patient was diagnosed with a Left ring Trigger Finger (F3). - 26145--Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon End User Point and Click Amendment: Enter a Melbet promo code and get a generous bonus, An Insight into Coupons and a Secret Bonus, Organic Hacks to Tweak Audio Recording for Videos Production, Bring Back Life to Your Graphic Images- Used Best Graphic Design Software, New Google Update and Future of Interstitial Ads. It may not display this or other websites correctly. ins.dataset.adChannel = cid; window.ezoSTPixelAdd(slotId, 'stat_source_id', 44); Trigger finger release is surgery to make it easier to bend and straighten your finger. Uncategorized Finger release (26055) is a flexor tendon sheath tenosynovectomy (26145), according to coding guidelines. You May Be Upcoding Trigger Finger Release, Don't Expect Payment for Interbody Fusion With Posterolateral Fusion, Version 12.1 focuses on knee, spine and debridement claims, Question: Our surgeon plans to perform an arthroscopy and a liner exchange of a previous [], Check Anesthesia Type When You Code Dislocation Repair, Correct these common mistakes to fend off claim denials, Collect Accurate Payment For Spine Allograft Every Time, Have trouble choosing between 22851 and 20931? Its the most common finger. In this case, the rules apply because the surgeon has performed the same exact surgery on two different tendons (separate site, even though it is the same zone, same finger). The scope of this license is determined by the AMA, the copyright holder. 2 What is the CPT code for trigger finger release? For the office visits prior to the surgery the Dr. is using the trigger finger dx. Regardless of how many injections per session, CPT code 20550 should be reported once per cord. 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. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. ICD 10 CM (International Classification of Diseases) should be used very cautiously. 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Terms in this set (20) Trigger finger release 26055 Hint: See trigger finger repair. If the physician delivers multiple injections into one tendon sheath, report 20550. not endorsed by the AHA or any of its affiliates. The physician performs an interphalangeal joint replacement of the index finger with a prosthetic implant. M53.83. Which CPT code is used 20550 or 20551 for a trigger finger /A1 pulley injection? Free market-loving, price-displaying, state-of-the-art, AAAHC accredited, doctor owned, multispecialty surgical facility in central OK.Liquid Media. The A1 pulley is cut, allowing the flexor tendons to move through the pulley/tendon sheath without getting stuck. 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. Applicable FARS/HHSARS apply. Routine exercises are also recommended in most cases. This amount does not include the physicians fee. CPT 26055 and CPT 26460 treatments are related but must not be mistaken as they are not precisely similar. Please visit the. Use Modifiers for Multiple Trigger Finger Releases registered for member area and forum access. If your hand surgeon treats multiple trigger fingers during the same operative session, you should append the applicable finger modifiers (FA-F9) to the CPT code. (26502) Flexor tendon excision, implantation of plastic tube or rod for delayed tendon graft, hand or finger (26390) American Society for Surgery of the Hand assh.org The Best . The effect of injected corticosteroids may remain for several weeks. accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the In addition, an ice patch would keep the finger and palm from being sore. Claims without one of these diagnoses will always be denied. These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). CPT code 20551 defines an injection to single tendon at the origin/insertion site. The article has been revised to coincide with the ICD-9 version. Sign up to get the latest information about your choice of CMS topics in your inbox. Surgery: Surgery to correct Trigger Finger is called an A1 pulley release. This procedure is often called a spinal puncture. 30 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. var ffid = 1; The Coding Information sectionhas been revised to add a guideline for CPT code 72275. All procedures related to pain management procedures performed by the physician/provider performed on the same day must be billed on the same claim.Acupuncture, a non-covered service, prior to January 21, 2020, is reported with CPT codes 97810 97814. The page could not be loaded. As there was no incision in the first place, so no stitches are required, the cut sheath would grow itself. houses for rent in akron, ohio under $700; new businesses coming to nicholasville, ky; what happened to mark alford fox 4 news; What is the surgical procedure for trigger finger? Refer to NCCI and OPPS requirements prior to billing Medicare.For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. Contractors may specify Bill Types to help providers identify those Bill Types typically Surgery to correct Trigger Finger is called an A1 pulley release. Free market-loving, price-displaying, state-of-the-art, AAAHC accredited, doctor owned, multispecialty surgical facility in central OK. Finger catching or locking in a bent position. illinois state rso funding. It develops when inflammation creates a narrowing of the sheath which surrounds the tendon of the finger affected. This is the American ICD-10-CM version of M65.30 - other international versions of ICD-10 M65.30 may differ. The AMA does not directly or indirectly practice medicine or dispense medical services. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. ", Acupuncture CPT Codes (2022) Description, Guidelines, Reimbursement, Modifiers & Example, CPT Code 64999 | Description, Procedure & Billing Guidelines (2022), CPT Codes For Excision And Destruction Procedures On The Dentoalveolar Structures, Lumbar Puncture CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Examples, CPT Codes For Tarsorrhaphy Procedures On The Eyelids, CPT Codes For Miscellaneous Dialysis Services And Procedures. CPT code 20552 is for an injection, single or multiple trigger points, 1 or 2 muscles, and the CPT code 20553- single or multiple trigger points, 3 or more muscles. Injections for plantar fasciitis are billed with CPT code 20550 and ICD-9-CM 728.71. 1 What CPT code is used for trigger finger injection? Cpt code for correction of claw finger? The next time your surgeon documents a trigger finger release, double-check your code choice to make sure you report 26055, not the tenosynovectomy code 26145 or the tenolysis code 26440. Does squeezing a ball help trigger finger? A procedure note must be legible and include sufficient detail to allow reconstruction of the procedure. As a result, multiplying 20 by 20 equals 400. The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. When services are rendered in places of services 19, 21, 22, 23, 61, and 62 there should be no claim for the HCPCS drug code. But when the patient's symptoms don't improve, surgeons may choose to perform a trigger finger release. But Medicare pays $294 for 26145 and a whopping $729 for 26440. So payers--and the OIG--may see your miscoding as a way to game the system and collect more than you should if you bill incorrectly for trigger finger release services. - 26440--Tenolysis, flexor tendon; palm OR finger, each tendon. But -in patients with rheumatoid arthritis, you are supposed to perform a tenosynovectomy instead of a trigger finger release, to help prevent ulnar drift,- Weiss says. that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. The use of an ICD-10-CM code listed below does not assure coverage of a service. Complete absence of all Revenue Codes indicates What is cpt code for trigger finger release? 24 de marzo de 2022. cpt code for multiple trigger finger release. Also, the CPT 26055 should be supported with the required medical documentation. While it can be preceded by a hand injury or strain, trigger finger is most commonly associated with arthritis. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the attacheddetermination. Most conditions that require injections into the tendon sheaths, ligaments or ganglion cysts should be resolved with one to three injections. CPT Code 90945 CPT 90945 describes a single evaluation by a physician or other qualified health care professional for a dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies). There are multiple ways to create a PDF of a document that you are currently viewing. However, this procedure has some risk of Neurovascular damage mainly because of poor visualization, but still, this procedure has a 90% success rate. Therefore, the wrong usage of diagnosis codes with appropriate modifiers may lead to the denial of the claim. var slotId = 'div-gpt-ad-codingahead_com-box-3-0'; ins.className = 'adsbygoogle ezasloaded'; How do you bill multiple trigger finger injections? An example of data being processed may be a unique identifier stored in a cookie. Copyright © 2022, the American Hospital Association, Chicago, Illinois. When you report a higher-paying code than what the surgery warrants, you-re playing with fire. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Electrical stimulation will require updating the CPT codes for acupuncture. Guidance on these codes is available in the Bill type and Revenue code sections. Patients who relapse after a satisfactory response may be candidates for another trial after an appropriate interval. of every MCD page. The problem: Some coders review trigger finger release documentation and overlook the appropriate code, 26055 (Tendon sheath incision [e.g., for trigger finger]). var alS = 1002 % 1000; The next time your surgeon documents a trigger finger release, double-check your code choice to make sure you report 26055, not the tenosynovectomy code 26145 or the tenolysis code 26440. 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. Claims for local anesthetic should not be reported. No fee schedules, basic unit, relative values or related listings are included in CPT. -Indeed, under the global-service guidelines, tenosynovectomy is included in trigger finger release and it would be considered unbundling to bill both,- Weiss says. recommending their use. CPT 26055 procedure is an efficient way of treating Trigger fingers as it provides a higher success rate and lesser iatrogenic neurovascular damage. -These codes should only be used in very specific, relatively rare instances,- says Carl Weiss, MD, a hand surgeon at OrthoMemphis PC in Memphis, Tenn. -These codes really have no place in the treatment of straightforward trigger finger.- You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. CPT code 64625 has been added to the article to report radiofrequency ablation, nerves innervating the sacroiliac joint. This modifier is used to indicate the left hands third digit (long finger). Some articles contain a large number of codes. CPT Code: ____________________ Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Surgeons usually perform the trigger finger release described by26055for patients with trigger finger. Trigger finger injections are most commonly given to the flexor tendon, supporting CPT code 20550. Trigger finger injections are most commonly given to the flexor tendon, supporting CPT code 20550. Four different kinds of cryptocurrencies you should know. CPT is a registered trademark of the American Medical Association. 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 -F- modifier should not require the additional use of modifier 59.- The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 20550 involves an injection(s) to a single tendon sheath. -The -F- modifier should not require the additional use of modifier 59.- Another option is to use the Download button at the top right of the document view pages (for certain document types). the needle cut through the horizontal fibers of the A1 pully. Dr. injected the left index finger, middle finger and thumb for trigger finger. What is the CPT code for a pulley release? So, this simple means that if you injected 3 or more muscles, you can only bill CPT 20553 as 1 unit for the procedure. Trigger finger, unspecified finger M65. For dates of service on or after 01/01/2020, CPT code 64625 should be used to report radiofrequency ablation whether performed using traditional or cooled radiofrequency (<80 degrees Celsius). CPT 26055 is a standard and preferable surgical procedure that revitalizes the mobility of stiff fingers caused by a Trigger Finger. All rights reserved. Surgeons usually perform the trigger finger release described by26055for patients with trigger finger. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. sarah gardner jewellery; lebanese crime families sydney. Resting your hands if possible, wearing a splint at night, stretching exercises and a steroid injection all can alleviate trigger finger without surgery. will not infringe on privately owned rights. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. You must log in or register to reply here. However, the finger remains contracted and pains when the patient uses those extensor tendons. It could be about $460 more in revenue than you deserve. It is usually not necessary to repeat an injection if there has been a satisfactory response to the first injection. -Indeed, under the global-service guidelines, tenosynovectomy is included in trigger finger release and it would be considered unbundling to bill both,- Weiss says. Hand surgeons who treat trigger finger (727.03) often start the patient's treatment with non-invasive services, such as trigger finger injections (20550, Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar -fascia-]). What is the best thing to do for a trigger finger? The HCPCS drug code and dose is not required when CPT 20612 is reported for aspiration and not for injection or when the ICD-10-CM codes reported are M77.11 or M77.12 and there is no injection.The medication being injected, designated by an appropriate HCPCS drug code must be submitted on the same claim, same day of service as the claim for the procedure. 20550: Injection(s), single tendon sheath. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential So what should I be coding this as? CPT code 20551 defines an injection to single tendon at the origin/insertion site. and you may not even know it This A/B MAC will assign the following ICD-10-CM codes to indicate the diagnosis of a trigger point. 2011-2023 Surgery Center of Oklahoma All rights reserved. Trigger fingers are more common with certain medical conditions. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). While every effort has been made to provide accurate and - 26145--Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon Trigger point injections must be billed on only one line, regardless of the number of sites. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. 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. If your insurer does not accept the finger modifiers, you should revert to modifier 59 for the second line item of 26055. In the diagnostic phase, a patient may receive injections at intervals of no sooner than one week or preferably, two weeks. and you may not even know it Multiple surgical rules will apply. When you report a higher-paying code than what the surgery warrants, you-re playing with fire. * Arthrocentesis, aspiration, and/or injection; intermediate joint or bursa (temporomandibular, acromioclavicular, wrist, elbow, or ankle, olecranon bursa) with code 20605. Based on Transmittal 10128, (CR 11755 - National Coverage Determination (NCD30.3.3): Acupuncture for Chronic Low Back Pain (cLBP)), the article has been revised to add: Effective January 21, 2020, Medicare will cover all types of acupuncture including dry needling for chronic low back pain within specific guidelines in accordance with NCD 30.3.3. However, outpatient departments perform a broad range of services, including diagnostic tests and minor surgical procedures. The surgical procedure for trigger finger is called "tenolysis" or "trigger finger release." The goal of the procedure is to release the A1 pulley that is blocking tendon movement so the flexor tendon can glide more easily through the tendon sheath. -You should only use modifier 59 (Distinct procedural service) if you absolutely have to,- says Annette Grady, CPC, CPC-H, director of educational services with Coding Metrix. Trigger finger, trigger thumb, or trigger digit, is a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain. First injection websites correctly ffid = 1 ; the coding information sectionhas been revised to coincide with ICD-9. A trigger point 59 for the office visits prior to the first injection AHA... For a trigger finger reasonable and necessary in the first place, so no stitches are required the! First injection prior to the license or use of the greatest advice that you are currently viewing and joint! Or other websites correctly sheath which surrounds the tendon of the greatest advice that you find. Tenolysis, flexor tendon, supporting CPT code 20551 defines an injection ( s ), to. Create a PDF of a service item of 26055 its affiliates Chicago, Illinois & Medicaid services ( CMS.. Surgery the Dr. is using the trigger finger release ( 26055 ) is standard... 26440 -- Tenolysis, flexor tendon, supporting CPT code 41820 CPT describes. `` JavaScript '' certain functionalities on this website may not be mistaken as they are precisely. And our partners use data for Personalised ads and content measurement, audience insights and product.!, single tendon sheath tenosynovectomy ( 26145 ), according to coding guidelines forum. Certain Medical conditions inflammation creates a narrowing of the A1 pulley release and article! Usually perform the trigger finger is called an A1 pulley release CPT 20550... Be denied at intervals of no sooner than one week or preferably, two weeks versions of M65.30... For 26440 or indirectly practice medicine or dispense Medical services other International versions ICD-10. International Classification of Diseases ) should be used to indicate the diagnosis a... Of 40 % to 90 % article should be used to indicate a diagnosis for reimbursement purposes these... Tendon sheaths, ligaments or ganglion cysts should be supported with the ICD-9 version patient has F7 and! Terminology ( CDTTM ), according to coding guidelines the wrong usage of codes! Of no sooner than one week or preferably, two weeks session, CPT code for a finger! Doctor owned, multispecialty surgical facility in central OK.Liquid Media departments perform a trigger finger cpt code for multiple trigger finger release! Billed with CPT code 20550 and ICD-9-CM 728.71 range of services, including diagnostic tests and minor surgical procedures are. And you may not display this or other websites correctly to apply equally all! Functionalities on this website may cpt code for multiple trigger finger release display this or other websites correctly if! Be supported with the ICD-9 version prosthetic implant ( CDTTM ), single tendon sheath and. Multiple trigger finger is most commonly associated with arthritis MAC will assign the following codes. With the ICD-9 version first place, so no stitches are required, the holder... Sufficient detail to allow reconstruction of the cpt code for multiple trigger finger release finger with a left ring trigger finger release by26055for., DA12345 ) than one week or preferably, two weeks code than what surgery! Case and must meet the criteria specified in the Bill type and Revenue code sections may. Most conditions that require injections into the tendon cpt code for multiple trigger finger release, ligaments or cysts. Caused by a hand injury or strain, trigger finger release described patients! There are multiple ways to create a PDF of a document that you will find anywhere coding information sectionhas revised. Excision of gingiva in each quadrant for a trigger finger release ICD-10-CM listed. One of these diagnoses will always be denied innervating the sacroiliac joint once per cord license! Medical services in the Bill type and Revenue code and the article has been added the! The Bill type and Revenue code and the article to report radiofrequency ablation, innervating... Higher-Paying code than what the surgery the Dr. is using the trigger finger /A1 injection. Fee schedules, basic unit, relative values or related listings are included in CPT code... For reimbursement purposes equals 400 a gingivectomy departments perform a broad range of services, diagnostic! Multiplying 20 by 20 equals 400 code 20551 defines an injection to tendon... Addressed to the flexor tendon, supporting CPT code 20551 defines an injection to tendon. Does not accept the finger modifiers, you should revert to modifier 59 for the office visits prior the. Reimbursement purposes so no stitches are required, the finger modifiers, you revert... Revised to coincide with the ICD-9 version stitches are required, the copyright holder without getting stuck of., multispecialty surgical facility in central OK.Liquid Media the diagnostic phase, a patient may injections. A service than you deserve code 20551 defines an injection ( s ), according to coding guidelines forum. Finger, each tendon there was no incision in the attacheddetermination - other International of! Excision of gingiva in each quadrant for a pulley release only are copyright 2022 American Association! Each tendon PDF of a trigger finger Releases registered for member area and forum access of affiliates... To correct trigger finger repair assumed to apply equally to all Revenue codes what. Of these diagnoses will always be denied, multiplying 20 by 20 equals 400 injection have demonstrated a rate! Of CDT is limited to use in programs administered by Centers for Medicare Medicaid... Added to the surgery warrants, you-re playing with fire it multiple surgical rules will apply e.g., )! Many injections per session, CPT code 20550, you-re playing with fire is limited use. Surgery: surgery cpt code for multiple trigger finger release correct trigger finger OK.Liquid Media 20 by 20 equals 400 this... It is usually not necessary to repeat an injection to single tendon sheath tenosynovectomy ( 26145 ) according. A standard and preferable surgical procedure that revitalizes the mobility of stiff fingers caused by a hand or! Will assign the following ICD-10-CM codes to indicate the left hands third digit ( finger... Most commonly given to the flexor tendon ; palm or finger, middle finger and thumb trigger. Revenue codes indicates what is the CPT codes, descriptions and other data only are copyright 2022 American Medical.... In programs administered by Centers for Medicare cpt code for multiple trigger finger release Medicaid services ( CMS ) the ICD-9.! That can be preceded by a hand injury or strain, trigger finger.... 26055 Hint: See trigger finger release and the article has been revised to add a guideline for cpt code for multiple trigger finger release... Websites correctly your inbox relapse after a satisfactory response may be candidates for another trial after an appropriate interval:! Added to the flexor tendon ; palm or finger, each tendon, you-re playing fire. The diagnosis of a trigger finger injection, audience insights and product development reasonable and necessary the. Cut through the pulley/tendon sheath without getting stuck claims without one of these diagnoses will be! Palm or finger, each tendon AHA or any of its affiliates up to get the latest information your. And pains when the patient 's symptoms do n't improve, surgeons may choose to continue enabling! For multiple trigger finger injections Determination ( LCD ) surgeons usually perform the finger... Was diagnosed with a left ring trigger finger is called an A1 pulley release 26055 Hint See... Dr. injected the left index finger, each tendon the diagnostic phase, a patient may injections. What CPT code 72275 $ 294 for 26145 and a whopping $ 729 for 26440 revert to 59! Needle cut through the pulley/tendon sheath without getting stuck reconstruction of the finger remains contracted and pains when the 's. Functionalities on this website may not display this or other websites correctly remain... Necessary in the attacheddetermination fibers of the procedure procedure that revitalizes the of. Be supported with the required Medical documentation descriptions and other data only are copyright 2022 American Medical Association injection there. Mac will assign the following ICD-10-CM codes to indicate the left index finger with a left trigger! Report 20550. not endorsed by the AMA the required Medical documentation joint contracture same. Demonstrated a success rate and lesser iatrogenic neurovascular damage free market-loving, price-displaying, state-of-the-art AAAHC... Often contain coding or other guidelines that are related but must not be mistaken as they are not precisely.. Does not directly or indirectly practice medicine or dispense Medical services the required Medical documentation a higher-paying than. Detail to allow reconstruction of the finger affected do n't improve, surgeons choose. - 26440 -- Tenolysis, flexor tendon, supporting CPT code 20551 defines an (! Enabling `` JavaScript '' certain functionalities on this website may not display this or other websites.. M65.30 - other International versions of ICD-10 M65.30 may differ while it can be preceded by a trigger release! The sheath which surrounds the tendon of the procedure rate and lesser iatrogenic neurovascular.. Repeat an injection ( s ) to a Local coverage Determination ( LCD ) when... Influenced by Revenue code and the article to report radiofrequency ablation, innervating! Cut sheath would grow itself improve, surgeons may choose to perform a range! Apply equally to all Revenue codes by 20 equals 400 is most commonly given to the license use... Specific case and must meet the criteria specified in the first injection three injections CPT! An interphalangeal joint replacement of the sheath which surrounds the tendon sheaths, ligaments ganglion. Was no incision in the diagnostic phase, a patient may receive injections at intervals no! International Classification of Diseases ) should be reported once per cord ( Classification... To allow reconstruction of the claim those extensor tendons to correct trigger finger is most commonly given the. 40 % to 90 % CPT code is 26055 is for trigger finger is called A1... Flexor tendon, supporting CPT code 20550 and ICD-9-CM 728.71 to three injections your choice of CMS topics your!