I am having a difficult time understanding exactly where the physician is working during this patient’s hand/ wrist surgery. Would anyone be able to guide me in the right direction or advise if I should query my physician?
Based on the description of the procedure I originally thought the work was being completed in the wrist _ Removal of hardware (20680 completed here) The physician’s office also obtained authorization for CPT 25260 - After much thought I am thinking this may not be the correct code.
I have looked at CPT 26356 however this code states without free graft, then I looked at CPT 26489. The palmaris longus tendon is harvested – based on the diagnosis the tendon rupture is in the thumb, I do not see where a second incision was made in the thumb, at first I thought the tendon ruptured off of the distal radius plate in wrist, now I am thinking it was off of the volar plateof the thumb. Would you choose either of these codes 26489 or 26356 and would I be correct in thinking the removal of hardware is inclusive to the repair * unless a seperate incison was made?
POSTOPERATIVE DIAGNOSES: 1. Right thumb flexor pollicis longus tendon attritional rupture. 2. Retained hardware, right volar distal radius.
OPERATIONS PERFORMED: 1. Repair of right thumb flexor pollicis longus tendon with palmaris longus autograft. 2. Removal of hardware, right distal radius.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and placed in the supine position on the operating room table. General anesthesia was administered without complications. The right upper extremity was prepped and draped in the usual sterile manner. The tourniquet was inflated to 250 mmHg pressure. The old distal radius incision was opened. It was dissected down through the skin and subcutaneous tissues. The FCR tendon was identified. It was freed up of all scar tissue, and the distal radius plate essentially exposed. The screws were all exposed, and the screws were removed as well as the plate. It was a Synthes plate. The bone was smoothed down. Next, the FPL tendon was identified. It had clearly ruptured on the plate. I was able to mobilize it fairly well. I had about a 1-cm defect. I thought the best option would be to harvest the palmaris longus tendon. This was done. The palmaris longus tendon was harvested, and then, it was used to repair the FPL tendon as a tendon graft, connecting the two ends of the FPL tendon. This was done with multiple Pulvertaft type weaves on the either sides with a 3-0 Ethibond. After doing that, there was fairly good resting tension on the thumb. The wound was washed out vigorously. Hemostasis was obtained. The skin was closed with 4-0 Monocryl sutures, followed by Benzoin, Steri-Strips, 4x4s, Sof-Rol, and a dorsal block thumb splint with the thumb in flexion.
Thank you for any insight you may offer and taking the time to read my post.
Based on the description of the procedure I originally thought the work was being completed in the wrist _ Removal of hardware (20680 completed here) The physician’s office also obtained authorization for CPT 25260 - After much thought I am thinking this may not be the correct code.
I have looked at CPT 26356 however this code states without free graft, then I looked at CPT 26489. The palmaris longus tendon is harvested – based on the diagnosis the tendon rupture is in the thumb, I do not see where a second incision was made in the thumb, at first I thought the tendon ruptured off of the distal radius plate in wrist, now I am thinking it was off of the volar plateof the thumb. Would you choose either of these codes 26489 or 26356 and would I be correct in thinking the removal of hardware is inclusive to the repair * unless a seperate incison was made?
POSTOPERATIVE DIAGNOSES: 1. Right thumb flexor pollicis longus tendon attritional rupture. 2. Retained hardware, right volar distal radius.
OPERATIONS PERFORMED: 1. Repair of right thumb flexor pollicis longus tendon with palmaris longus autograft. 2. Removal of hardware, right distal radius.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and placed in the supine position on the operating room table. General anesthesia was administered without complications. The right upper extremity was prepped and draped in the usual sterile manner. The tourniquet was inflated to 250 mmHg pressure. The old distal radius incision was opened. It was dissected down through the skin and subcutaneous tissues. The FCR tendon was identified. It was freed up of all scar tissue, and the distal radius plate essentially exposed. The screws were all exposed, and the screws were removed as well as the plate. It was a Synthes plate. The bone was smoothed down. Next, the FPL tendon was identified. It had clearly ruptured on the plate. I was able to mobilize it fairly well. I had about a 1-cm defect. I thought the best option would be to harvest the palmaris longus tendon. This was done. The palmaris longus tendon was harvested, and then, it was used to repair the FPL tendon as a tendon graft, connecting the two ends of the FPL tendon. This was done with multiple Pulvertaft type weaves on the either sides with a 3-0 Ethibond. After doing that, there was fairly good resting tension on the thumb. The wound was washed out vigorously. Hemostasis was obtained. The skin was closed with 4-0 Monocryl sutures, followed by Benzoin, Steri-Strips, 4x4s, Sof-Rol, and a dorsal block thumb splint with the thumb in flexion.
Thank you for any insight you may offer and taking the time to read my post.
