Ganglion excision
Statutory Guidance
Summary
Ganglia are cystic swellings containing jelly-like fluid which form around the wrists or in the hand. In most cases wrist ganglia cause only mild symptoms which do not restrict function, and many resolve without treatment within a year. Wrist ganglion rarely press on a nerve or other structure, causing pain and reduced hand function.
Ganglia in the palm of the hand (seed ganglia) can cause pain when carrying objects.
Ganglia which form just below the nail (mucous cysts) can deform the nail bed and discharge fluid, but occasionally become infected and can result in septic arthritis of the distal finger joint.
Recommendation
Wrist ganglia,
- no treatment unless causing pain or tingling/numbness or concern (worried it is a cancer);
- aspiration if causing pain, tingling/numbness or concern
- surgical excision only considered if aspiration fails to resolve the pain or tingling/numbness and there is restricted hand.
Seed ganglia that are painful,
- puncture/aspirate the ganglion using a hypodermic needle
- surgical excision only considered if ganglion persists or recurs after puncture/aspiration.
Mucous cysts no surgery considered unless recurrent spontaneous discharge of fluid or significant nail deformity.
Rationale for recommendation
Most wrist ganglia get better on their own. Surgery causes restricted wrist and hand function for 4-6 weeks, may leave an unsightly scar and be complicated by recurrent ganglion formation. Aspiration of wrist ganglia may relieve pain and restore hand function, and “cure” a minority (30%). Most ganglia reform after aspiration but they may then be painless. Aspiration also reassures the patient that the swelling is not a cancer but a benign cyst full of jelly.
Complication and recurrence are rare after aspiration and surgery for seed ganglia.
Patient information
Information for Patients
Surgery to remove a ganglion should only be carried out when specific criteria are met. This is because the medical evidence tells us that the intervention can sometimes do more harm than good. There are alternative treatments and often no treatment is needed.
About the condition
A ganglion is a swelling filled with clear jelly that usually develops near a joint or tendon. Ganglia can occur alongside any joint in the body, but are most common on the wrist, hands and fingers. They can range from the size of a small seed to the size of a golf ball and they feel like a smooth lump under the skin.
Ganglia at the wrist rarely cause significant symptoms, but can be uncomfortable and sometimes painful. Ganglia in the palm of your hand may cause discomfort when carrying objects.
The clinician treating you may insert a hypodermic needle into the ganglion to establish that the lump is nothing more than a cyst full of jelly. Sometimes this procedure itself relieves the pain and gets rid of the ganglion, but many come back. If the ganglion does come back it does not always need further treatment. If it causes sufficiently troublesome symptoms which interfere with hand function then surgical removal may be considered.
It’s important you and your doctor make a shared decision about what’s best for you if your ganglion is becoming a problem. When deciding what’s best you should both consider the benefits, the risks, the alternatives and what will happen if you do nothing.
What are the BENEFITS of the intervention?
Surgery can relieve pain and discomfort and improve hand function if needle aspiration has not been successful.
What are the RISKS?
The risks of surgery include pain, bleeding, infection, scarring and recurrence of the ganglion. It can take up to six weeks to recover and for your hand function to return fully
What are the ALTERNATIVES?
If the ganglion is not causing troublesome symptoms there is no need to do anything, and it may well resolve spontaneously in time.
What if you do NOTHING?
Doing nothing will not be harmful to your health and most ganglia go away in time without treatment. Most people are not bothered by ganglia and treatment should only be considered if there are significant symptoms or restrictions.
Coding
Code script
WHEN LEFT(der.Spell_Dominant_Procedure,4) in ('T591','T592','T601','T602')
AND (der.Spell_Primary_Diagnosis like '%M674%’
OR der.Spell_Primary_Diagnosis like '%M255%')
AND apcs.der_diagnosis_all not like '%M258%’
AND APCS.Admission_Method not like ('2%')
THEN 'O_ganglion'
Code Definitions
Procedure codes (OPCS)
Main
T591 Excision of ganglion of wrist
T592 Excision of ganglion of hand NEC
T601 Re-excision of ganglion of wrist
T602 Re-excision of ganglion of hand NEC
Potential
T611 Aspiration of ganglion
T613 Injection of ganglion
T618 Other specified other operations on ganglion
T598 Other specified excision of ganglion
T599 Unspecified excision of ganglion
T608 Other specified re-excision of ganglion
T609 Unspecified re-excision of ganglion
Diagnosis codes (ICD)
Includes
M674 Ganglion (nothing to state that this is severe as per policy. Also nothing to demonstrate the site (although this can be picked up from the OPCS-4 code))
M255 Pain in joint (this code might be used to demonstrate that there is pain involved, but not a guarantee (fifth character would be ‘0’, ‘4’ or ‘7’))
Exclusions
M258 Other specified joint disorders (this is where cyst of joint is classified so might be used as a bypass)
Additional Exclusions
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and apcs.der_diagnosis_all not like '%D0%' and apcs.der_diagnosis_all not like '%D3[789]%' and apcs.der_diagnosis_all not like '%D4[012345678]%’
This code captures code in the ranges C00-C99, D00-D09 and D37-D48.
Age range: the codes use the following age ranges 0-18 for children and 19-120
for adults.
— Private Appointment Exclusion
AND apcs.Administrative_Category<>’02’
References
- Head L, Gencarelli JR, Allen M, Boyd KU. Wrist ganglion treatment: Systematic review and meta-analysis. J Hand Surg Am. 2015, 40: 546-53
- Naam NH, Carr SB, Massoud AH. Intraneural Ganglions of the Hand and J Hand Surg Am. 2015 Aug;40(8):1625-30. doi: 10.1016/j.jhsa.2015.05.025. PubMed PMID: 26213199.
- BSSH (2016) Ganglion cysts.
How up to date is this information?
Last revised December 2023
Changes
December 2023 - Coding updated. August 2022 - Coding updated
