afryberger
Networker
Operative Report:
The patient was brought to the operating room where sedation was administered. A median nerve block was administered, a tourniquet was placed on the patient's right upper extremity and the right upper extremity was prepped and draped in the appropriate sterile manner. Tourniquet was inflated. A curvilinear incision, approximately 4 cm in length was made, in line with the radial aspect of the ring finger, ending 4 mm distal to the distal wrist crease. Blunt dissection was performed, and the palmar aponeurosis was visualized. It was then incised, and retracted out of the way. The transverse carpal ligament was then visualized, and under direct visualization, the transverse carpal ligament was sharply incised in a step cut fashion for later reconstruction. Using a Senn retractor, the antebrachial fascia was visualized proximally, and under direct visualization the antebrachial fascia was completely incised using iris scissors. Complete release was confirmed by visualization, as well as the surgeon placing the small finger proximally in the wound, and no bands, or areas of compression were palpated. Next attention was directed distally. The distal portion of the transverse carpal ligament was released, and the digital branches of the median nerve visualized. Next, attention was directed to the motor branch. It was visualized, and noted to be intact. Next attention was redirected to the transverse carpal ligament. The two ends were then reconstructed with 4-0 Vicryl increasing the space approximately 7mm to maintaining tendon gliding and grip strength. Examination confirmed that there were no areas of compression and free tendon gliding. Tourniquet was released, there was no active bleeding, and all other bleeding was stopped using bipolar cautery. The wound was closed 4-0 nylon sutures, followed by a sterile dressing, followed by a volar splint. The patient was then transferred to recovery room in stable condition.
My question is do you bill anything for the transverse carpal ligament repair? Is this included? 25320??
The patient was brought to the operating room where sedation was administered. A median nerve block was administered, a tourniquet was placed on the patient's right upper extremity and the right upper extremity was prepped and draped in the appropriate sterile manner. Tourniquet was inflated. A curvilinear incision, approximately 4 cm in length was made, in line with the radial aspect of the ring finger, ending 4 mm distal to the distal wrist crease. Blunt dissection was performed, and the palmar aponeurosis was visualized. It was then incised, and retracted out of the way. The transverse carpal ligament was then visualized, and under direct visualization, the transverse carpal ligament was sharply incised in a step cut fashion for later reconstruction. Using a Senn retractor, the antebrachial fascia was visualized proximally, and under direct visualization the antebrachial fascia was completely incised using iris scissors. Complete release was confirmed by visualization, as well as the surgeon placing the small finger proximally in the wound, and no bands, or areas of compression were palpated. Next attention was directed distally. The distal portion of the transverse carpal ligament was released, and the digital branches of the median nerve visualized. Next, attention was directed to the motor branch. It was visualized, and noted to be intact. Next attention was redirected to the transverse carpal ligament. The two ends were then reconstructed with 4-0 Vicryl increasing the space approximately 7mm to maintaining tendon gliding and grip strength. Examination confirmed that there were no areas of compression and free tendon gliding. Tourniquet was released, there was no active bleeding, and all other bleeding was stopped using bipolar cautery. The wound was closed 4-0 nylon sutures, followed by a sterile dressing, followed by a volar splint. The patient was then transferred to recovery room in stable condition.
My question is do you bill anything for the transverse carpal ligament repair? Is this included? 25320??
