Avulsion of finger-- help please!!

laurabee

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Yikes, ok I get that the ORIF code would be 26735 (right?) with 816.01 as the dx but how in the world do you code the avulsion? When trying to look up the dx I keep getting "see sprain" and I don't even know where to start with the avulsion repair CPT code!!

PREOPERATIVE DIAGNOSES:
1. Fracture dislocation of left fifth finger PIP joint-fracture of volar base of left fifth finger middle phalanx.

2. Avulsion of volar plate of the left fifth finger PIP joint.

POSTOPERATIVE DIAGNOSES:
1. Fracture dislocation of left fifth finger PIP joint-fracture of volar base of left fifth finger middle phalanx.

2. Avulsion of volar plate of the left fifth finger PIP joint.

PROCEDURES PERFORMED:
1. Open reduction internal fixation of left fifth finger middle phalanx fracture-intraarticular.

2. Repair of avulsion of left fifth finger volar plate-volar joint capsule.


ANESTHESIA: General endotracheal.


ESTIMATED BLOOD LOSS: Less than 10 cc.

BRIEF DESCRIPTION OF OPERATIVE INDICATIONS: The patient is a 44-year-old female who sustained an injury during a sports activity to her left fifth finger on 05/21/2009. The patient was seen by emergency personnel who attempted reduction of the patient's dislocation fracture, but this was unsuccessful and the patient's PIP joint of fifth finger remained unstable. The patient was determined to have a fracture dislocation of the PIP joint with a large volar segment of middle phalanx bone being avulsed away along with the tear and avulsion of the volar plate. The patient was felt to require an open reduction, internal fixation of the fracture and repair of the volar plate or ligamentous injury.

BRIEF DESCRIPTION OF OPERATIVE TECHNIQUES AND FINDINGS: The patient was placed on the operating room table in supine position. A general anesthetic was administered through an endotracheal route. The patient's arm was then prepped and draped and the operative procedure begun by exploring the patient's left fifth finger and performing an open reduction and internal fixation of the left fifth finger volar middle phalanx fracture. This was performed by dissecting through the flexor tendon sheath and openly reducing the fracture. The fracture was fixed using 2.028 K-wires that were drilled in a retrograde fashion from volar to dorsally. With this in place and satisfactory fracture reduction obtained. The patient had the volar plate tear repaired by elevating and advancing the plate and sewing it in position with three 4-0 Vicryl sutures. Completing this the patient wounds were irrigated and closed with interrupted nylon suture and a 0.5% Marcaine. Digital block was applied. The hand was dressed with antibiotic ointment, sterile gauze dressings and a protective ulnar gutter fiberglass splint. The patient tolerated the procedure well and no immediate postoperative issues were seen.
 
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