Orthopedic Coding Alert

You could be missing out on reimbursement if you don't thoroughly read the op note. If coding hand surgeries involving a slew of specific terms has you scratching your head, a few minutes brushing up on your hand anatomy could be just what you need to improve your hand surgery acumen. Here's how: Take a look at the following hand surgery and see if you-re on par with our expert provided coding recommendations. Note: The following op note was provided by Chris Ford with the billing department of Coastal Orthopedics and Sports Medicine Group in Oceanside, Calif. Do you have a difficult case? Send your op note to the editor (suzannel@eliresearch.com) and see it discussed in future Orthopedic Coding Alert issues! First, Read This Op Note Pre-op dx: Right hand wound dehiscence with extensor tendon ruptures and open wound Post-op dx: Right hand wound dehiscence with extensor tendon ruptures and open wound Procedures: 1) Extensor tendon repair, extensor digitorum communis, right long finger 2) Extensor digitorum communis, right index finger, tendon transfer, side-to-side to extensor indicis proprius 3) Right ring finger common extensor tendon side-to-side transfer to extensor of the long finger. 4) Right small finger common extensor tendon side-to-side transfer to extensor of the long finger. Indications: Patient had previous right hand extensor tenosynovectomy. Postoperatively, this was complicated by wound dehiscence that was closed with delayed primary closure. She then dehisced again and underwent I&D with delayed primary closure. She dehisced a second time and ruptured two extensor tendons on the dorsum of the hand. She underwent irrigation and debridement and the extensor tendon rupture was primarily repaired. She was treated with local wound care. Findings: Ruptured extensor digitorum communis of the index finger, ring finger, and small finger. Intact extensor to the indicis proprius. Middle finger common extensor intact but necrotic. Intact extensor digiti minimi. Op report: [anesthesia and prep -] dorsal skin flaps around the open wound that were adherent to the extensor tendons were elevated and freed - all of the extensor tendons proximally and distally into normal tissue were freed up and the ends trimmed to normal, healthy-appearing tendons. The common extensor of the long finger was noted to have a necrotic central area, which was excised. The common extensor of the long finger was then repaired with Krakow stitch of 3-0 Ethibond reinforced with a running epitendinous suture of #4-0 nylon. The common extensor to the index finger was then woven into the extensor indicis proprius tendon under appropriate tension with three weaves with a Pulvertaft technique. Each weave point was secured with an interrupted box suture of #4-0 ethibond. The ring finger and small finger extensor tendons were then repaired in a side-to-side [...]