25332 vs 25447

daniel

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Hello All, I'm going with CPT 25332, but would like to know if any of you see it differently? Operation Performed: 1)left wrist resectional arthroplasty of scaphotrapezial and trapeziometacarpal joint without interposition And tight rope(CPT code 25332 vs 25447) 2) left epd tendon tenotomy (CPT 26460) Level of Involvement of Attending Surgeon: Present and scrubbed Indication for Operation: Persistent pain and stiffness, worse with use. Description of Operative Procedure: Time-out procedure was carried out. The upper extremity was prepped and draped under sterile fashion. After exsanguination, the tourniquet was elevated to 250 mmHg. An incision was made along the Wagner approach. The first metacarpal base was exposed after dissection and protection of the sensory branches. Then, the scaphotrapezial and trapeziometacarpal joints were visualized, and fluoroscopy was used to confirm joint locations. A 1.1mm arthrex tightrope k-wire was then passed from the base of the thumb mtc to the index mtc and a small incision was made dorsally over the 2nd metacarpal to accept the k-wire. A 1.1 mm tightrope was then passed but not tightened. Then, the scaphotrapezial and trapeziometacarpal joints were removed through trapezium excision, as well as the base of the trapezoid as there was arthritis present in this joint as well.. The tightrope was then tightened approripately with a washer on the 2nd metacarpal leaving space on xray between the 1st and 2nd mtc base with a small amount of shuck. An extensor policis brevis tenotomy was performed. The wounds were irrigated and capsule closed with the thumb extended with a 2-0 vicrly. Skin was closed with 4-0 nylon after tourniquet let down and hemostasis obtained. This was followed by 10 cc .25% marcaine with epi and sterile dressings and thumb spica splint. The tourniquet was released at 42 minutes. Specimens Removed: None Anesthesia Type: gen Incision: Wrist Blood Loss: Minimal Blood Products Administered: None Drains/Packs: None Skin Closure: primary Post-Operative Conditions: Stable
 

iowagirl77

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I would actually go with 25447; I've seen this surgery multiple times. I haven't seen one for 25332 before so I had to look that one up. Per the coder's desk reference, 25332 has to do with the carpal and radius/ulnar joints but 25447 has to do with the metacarpal and carpal joints.
 
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