dsibley67
Networker
Can someone please assist me in coding this op note? I have 25825, 25230, & 25215. I am sure about 25825, but not the rest. Also, not sure if all of these codes can be billed together. Per NCCI edits a modifier is allowed but I am ver hesitate to bill them together. Any help will be greatly appreciated. Thanks!
The patient was seen preoperatively, site was marked and
verified. Preoperative antibiotics were given. He was taken back to the OR. Time-out was taken at the
beginning of the procedure. A longitudinal incision was then made over the dorsal aspect of the wrist,
carefully dissected down exposing the retinaculum. The EPL tendon was identified and then released.
We then opened the retinaculum over the second and fourth dorsal compartments. At this point, the
posterior interosseous nerve was identified on the floor of the fourth compartment and transected the
proximal extent of the wound. We then performed a T-shaped capsulotomy, exposed the radiocarpal joint.
Scaphoid was translated and clearly had significant degenerative changes. We examined the proximal
surface of the lunate which appeared healthy. The distal radius appeared healthy in the lunate facet. He
did have significant wear along the radioscaphoid facet. At this point, we elected to proceed with a partial
fusion. The scaphoid was then removed with osteotome, rongeur and curette. The triquetrum was
removed likewise. We performed a radial styloidectomy using osteotome and removed approximately 5
mm along the radial styloid. We verified that the RSC ligament remained intact. We then prepared the
surface of the capitate and the distal edge of the lunate for fusion using a bur. We then pinned the lunate
and capitate into adequate alignment using a K-wire. Two nitinol staples were then secured across the
lunocapitate joint. We verified under C-arm adequate placement of the staples. The K-wire had been
removed. We placed bone graft from the scaphoid into the space left into the lunocapitate fusion side as
well. At this point, the wounds were irrigated. The capsule was closed with 3-0 Vicryl, retinaculum was
reapproximated with 3-0 Vicryl leaving EPL tendon transposed. Skin was closed. He was placed in a
volar splint and tolerated the procedure well
The patient was seen preoperatively, site was marked and
verified. Preoperative antibiotics were given. He was taken back to the OR. Time-out was taken at the
beginning of the procedure. A longitudinal incision was then made over the dorsal aspect of the wrist,
carefully dissected down exposing the retinaculum. The EPL tendon was identified and then released.
We then opened the retinaculum over the second and fourth dorsal compartments. At this point, the
posterior interosseous nerve was identified on the floor of the fourth compartment and transected the
proximal extent of the wound. We then performed a T-shaped capsulotomy, exposed the radiocarpal joint.
Scaphoid was translated and clearly had significant degenerative changes. We examined the proximal
surface of the lunate which appeared healthy. The distal radius appeared healthy in the lunate facet. He
did have significant wear along the radioscaphoid facet. At this point, we elected to proceed with a partial
fusion. The scaphoid was then removed with osteotome, rongeur and curette. The triquetrum was
removed likewise. We performed a radial styloidectomy using osteotome and removed approximately 5
mm along the radial styloid. We verified that the RSC ligament remained intact. We then prepared the
surface of the capitate and the distal edge of the lunate for fusion using a bur. We then pinned the lunate
and capitate into adequate alignment using a K-wire. Two nitinol staples were then secured across the
lunocapitate joint. We verified under C-arm adequate placement of the staples. The K-wire had been
removed. We placed bone graft from the scaphoid into the space left into the lunocapitate fusion side as
well. At this point, the wounds were irrigated. The capsule was closed with 3-0 Vicryl, retinaculum was
reapproximated with 3-0 Vicryl leaving EPL tendon transposed. Skin was closed. He was placed in a
volar splint and tolerated the procedure well