Wiki Bowers Hemi Resection Interposition Arthroplasty of the Wrist

[adunlap23]

The op note details a carpal tunnel release and release at Guyon's canal. It then goes on to detail the Bower's procedure: "Attention was then placed towards the dorsal aspect of the wrist where under loupe magnification a longitudinal incision was made over the distal radioulnar joint carried down through the subcutaneous tissue. Identified the fourth, fifth, and sixth dorsal compartments. I then incised the retinaculum just radial to the fifth dorsal compartment and created an ulnar based flap for later use. I then incised the distal radial ulnar joint where a mod amount of degenerative fluid was noted. Several loose bodies were also seen which were removed. With a combination of osteotome bur and rongeur and rasp I resected the distal ulna to the level of the diameter of the shaft distally. Care was taken to preserve the fovea and dorsal radial and ulnar ligament. I used a lamina spreader to gain access to the most volar aspect to complete the resection. AP supine an dpronation images demonstrated satisfactory resection. The wound was irrigated with saline solution. I then placed 4-0 Fiberwire suture x2 through the volar capsule. I then placed bone wax over the distal ulna and then repaired the retinaculum previously created down and over the ulnar to the volar capsule. Excellent stability was noted..." It goes on to detail surgical closure.

For anyone who is familiar with this procedure, I am confused as to where the interposition portion of the arthroplasty is happening. Is it where the Fiberwire sutures were placed through the volar capsule?

I am between 25332- arthroplasty, wrist, with or without interposition, with or without external or internal fixation and 25240-Excision distal ulna partial or complete.

Thoughts?

 

[NRaizman]

25240 and 25337.

The Bowers is a hemoresection of the ulna and is coded the same as a Darrach. The stabilization of the distal ulna is separate from the resection and is accomplished by interposing the capsular flap into the defect. It would be an easier sell if the surgeon had been more explicit about the stabilization portion of the procedure.

This is not a surgery on the wrist joint per se and the wrist arthroplasty code is not appropriate.

Cheers,
N

 

[adunlap23]

25240 and 25337.

The Bowers is a hemoresection of the ulna and is coded the same as a Darrach. The stabilization of the distal ulna is separate from the resection and is accomplished by interposing the capsular flap into the defect. It would be an easier sell if the surgeon had been more explicit about the stabilization portion of the procedure.

This is not a surgery on the wrist joint per se and the wrist arthroplasty code is not appropriate.

Cheers,
N

Thank you. This was extremely helpful.