afryberger
Networker
Ive been trying to figure this OP report out for hours now. I cant not find information and I feel this might be over coded.
The codes I got are:
26520
26520*4
26440
26440*8
26055
26055*4
I cant find information whether or not certain things are included. Also if because you have 9 tendons in your finger and they incise each one, do you bill it nine times.
PROCEDURE:
Patient was brought to the operating room where a block was administered. 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 transverse incision approximately was made over the distal palmar crease, extending from the index finger to the small finger. Attention was directed first to the small finger. Under blunt dissection, the radial and ulnar neurovascular
bundle were visualized and retracted out of the way. The A1 was then fully
visualized. Under direct visualization, the A1 pulley was incised, and a portion
was excised. Care was taken not to cut the A2 pulley, and under direct
visualization it was noted to fully intact. Next a clamp was placed under the
tendons, delivering them out of the sheath. It was noted that the tendons did not
glide freely, and there were adhesions between the tendons. A tenolysis of the
FDP and FDS tendons was performed. After this was performed, after placing a
clamp under each tendon individually, the tendons each had full excursion, and the
PIP and DIP joints flexed fully, however there was decreased motion at the MP joint, in flexion. The tendons were retracted, and the MP joint was visualized. The joint was sharply incied and a capsulotomy was performed, and a volar portion of the capsule was excised and sent to pathology. Using a Freer elevator, the intra-articular adhesions were lrealeased. After this was performed, there was full passive flexion at the MP joint.
Next, attention was directed to the ring finger.Under blunt dissection, the radial and ulnar neurovascular bundle were visualized and retracted out of the way. The A1 was then fully
visualized. Under direct visualization, the A1 pulley was incised, and a portion
was excised. Care was taken not to cut the A2 pulley, and under direct
visualization it was noted to fully intact. Next a clamp was placed under the
tendons, delivering them out of the sheath. It was noted that the tendons did not
glide freely, and there were adhesions between the tendons. A tenolysis of the
FDP and FDS tendons was performed. After this was performed, after placing a
clamp under each tendon individually, the tendons each had full excursion, and the
PIP and DIP joints flexed fully, however there was decreased motion at the MP joint, in flexion. The tendons were retracted, and the MP joint was visualized. The joint was sharply incied and a capsulotomy was performed, and a volar portion of the capsule was excised and sent to pathology. Using a Freer elevator, the intra-articular adhesions were lrealeased. After this was performed, there was full passive flexion at the MP joint.
Next, attention was directed to the middle finger.Under blunt dissection, the radial and ulnar neurovascular bundle were visualized and retracted out of the way. The A1 was then fully
visualized. Under direct visualization, the A1 pulley was incised, and a portion
was excised. Care was taken not to cut the A2 pulley, and under direct
visualization it was noted to fully intact. Next a clamp was placed under the
tendons, delivering them out of the sheath. It was noted that the tendons did not
glide freely, and there were adhesions between the tendons. A tenolysis of the
FDP and FDS tendons was performed. After this was performed, after placing a
clamp under each tendon individually, the tendons each had full excursion, and the
PIP and DIP joints flexed fully, however there was decreased motion at the MP joint, in flexion. The tendons were retracted, and the MP joint was visualized. The joint was sharply incied and a capsulotomy was performed, and a volar portion of the capsule was excised and sent to pathology. Using a Freer elevator, the intra-articular adhesions were lrealeased. After this was performed, there was full passive flexion at the MP joint.
Next, attention was directed to the index finger.Under blunt dissection, the radial and ulnar neurovascular bundle were visualized and retracted out of the way. The A1 was then fully
visualized. Under direct visualization, the A1 pulley was incised, and a portion
was excised. Care was taken not to cut the A2 pulley, and under direct
visualization it was noted to fully intact. Next a clamp was placed under the
tendons, delivering them out of the sheath. It was noted that the tendons did not
glide freely, and there were adhesions between the tendons. A tenolysis of the
FDP and FDS tendons was performed. After this was performed, after placing a
clamp under each tendon individually, the tendons each had full excursion, and the
PIP and DIP joints flexed fully, however there was decreased motion at the MP joint, in flexion. The tendons were retracted, and the MP joint was visualized. The joint was sharply incied and a capsulotomy was performed, and a volar portion of the capsule was excised and sent to pathology. Using a Freer elevator, the intra-articular adhesions were lrealeased. After this was performed, there was full passive flexion at the MP joint.
Next, attention was directed to the thumb.A transverse incision approximately 15 mm was made over the
metacarpal neck. Under blunt dissection, the radial and ulnar neurovascular
bundle were visualized and retracted out of the way. The A1 was then fully
visualized. Under direct visualization, the A1 pulley was incised, and a portion
was excised. Care was taken not to cut the A2 pulley, and under direct
visualization it was noted to fully intact. Next, a clamp was placed under the FPL
tendon, delivering it out of the sheath. It was noted that the tendon did not
glide freely, and there were adhesions. A tenolysis of the
FPL tendon was performed, however there was persistent MP stifness. The tendon was retracted, and the MP joint was visualized. The joint was sharply incised and a capsulotomy was performed, and a volar portion of the capsule was excised and sent to pathology. Using a Freer elevator, the intra-articular adhesions were realeased. After this was performed, there was full passive flexion at the MP joint.
After this was performed, after placing a clamp under the tendon, the tendon had full excursion, and the IP joint flexed fully.
Tourniquet was taken down. There was no active bleeding. All other
bleeding was stopped using bipolar. The wound was closed with 4-0 nylon sutures.
A sterile dressing was placed, and patient was taken to recovery room in stable
condition.
The codes I got are:
26520
26520*4
26440
26440*8
26055
26055*4
I cant find information whether or not certain things are included. Also if because you have 9 tendons in your finger and they incise each one, do you bill it nine times.
PROCEDURE:
Patient was brought to the operating room where a block was administered. 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 transverse incision approximately was made over the distal palmar crease, extending from the index finger to the small finger. Attention was directed first to the small finger. Under blunt dissection, the radial and ulnar neurovascular
bundle were visualized and retracted out of the way. The A1 was then fully
visualized. Under direct visualization, the A1 pulley was incised, and a portion
was excised. Care was taken not to cut the A2 pulley, and under direct
visualization it was noted to fully intact. Next a clamp was placed under the
tendons, delivering them out of the sheath. It was noted that the tendons did not
glide freely, and there were adhesions between the tendons. A tenolysis of the
FDP and FDS tendons was performed. After this was performed, after placing a
clamp under each tendon individually, the tendons each had full excursion, and the
PIP and DIP joints flexed fully, however there was decreased motion at the MP joint, in flexion. The tendons were retracted, and the MP joint was visualized. The joint was sharply incied and a capsulotomy was performed, and a volar portion of the capsule was excised and sent to pathology. Using a Freer elevator, the intra-articular adhesions were lrealeased. After this was performed, there was full passive flexion at the MP joint.
Next, attention was directed to the ring finger.Under blunt dissection, the radial and ulnar neurovascular bundle were visualized and retracted out of the way. The A1 was then fully
visualized. Under direct visualization, the A1 pulley was incised, and a portion
was excised. Care was taken not to cut the A2 pulley, and under direct
visualization it was noted to fully intact. Next a clamp was placed under the
tendons, delivering them out of the sheath. It was noted that the tendons did not
glide freely, and there were adhesions between the tendons. A tenolysis of the
FDP and FDS tendons was performed. After this was performed, after placing a
clamp under each tendon individually, the tendons each had full excursion, and the
PIP and DIP joints flexed fully, however there was decreased motion at the MP joint, in flexion. The tendons were retracted, and the MP joint was visualized. The joint was sharply incied and a capsulotomy was performed, and a volar portion of the capsule was excised and sent to pathology. Using a Freer elevator, the intra-articular adhesions were lrealeased. After this was performed, there was full passive flexion at the MP joint.
Next, attention was directed to the middle finger.Under blunt dissection, the radial and ulnar neurovascular bundle were visualized and retracted out of the way. The A1 was then fully
visualized. Under direct visualization, the A1 pulley was incised, and a portion
was excised. Care was taken not to cut the A2 pulley, and under direct
visualization it was noted to fully intact. Next a clamp was placed under the
tendons, delivering them out of the sheath. It was noted that the tendons did not
glide freely, and there were adhesions between the tendons. A tenolysis of the
FDP and FDS tendons was performed. After this was performed, after placing a
clamp under each tendon individually, the tendons each had full excursion, and the
PIP and DIP joints flexed fully, however there was decreased motion at the MP joint, in flexion. The tendons were retracted, and the MP joint was visualized. The joint was sharply incied and a capsulotomy was performed, and a volar portion of the capsule was excised and sent to pathology. Using a Freer elevator, the intra-articular adhesions were lrealeased. After this was performed, there was full passive flexion at the MP joint.
Next, attention was directed to the index finger.Under blunt dissection, the radial and ulnar neurovascular bundle were visualized and retracted out of the way. The A1 was then fully
visualized. Under direct visualization, the A1 pulley was incised, and a portion
was excised. Care was taken not to cut the A2 pulley, and under direct
visualization it was noted to fully intact. Next a clamp was placed under the
tendons, delivering them out of the sheath. It was noted that the tendons did not
glide freely, and there were adhesions between the tendons. A tenolysis of the
FDP and FDS tendons was performed. After this was performed, after placing a
clamp under each tendon individually, the tendons each had full excursion, and the
PIP and DIP joints flexed fully, however there was decreased motion at the MP joint, in flexion. The tendons were retracted, and the MP joint was visualized. The joint was sharply incied and a capsulotomy was performed, and a volar portion of the capsule was excised and sent to pathology. Using a Freer elevator, the intra-articular adhesions were lrealeased. After this was performed, there was full passive flexion at the MP joint.
Next, attention was directed to the thumb.A transverse incision approximately 15 mm was made over the
metacarpal neck. Under blunt dissection, the radial and ulnar neurovascular
bundle were visualized and retracted out of the way. The A1 was then fully
visualized. Under direct visualization, the A1 pulley was incised, and a portion
was excised. Care was taken not to cut the A2 pulley, and under direct
visualization it was noted to fully intact. Next, a clamp was placed under the FPL
tendon, delivering it out of the sheath. It was noted that the tendon did not
glide freely, and there were adhesions. A tenolysis of the
FPL tendon was performed, however there was persistent MP stifness. The tendon was retracted, and the MP joint was visualized. The joint was sharply incised and a capsulotomy was performed, and a volar portion of the capsule was excised and sent to pathology. Using a Freer elevator, the intra-articular adhesions were realeased. After this was performed, there was full passive flexion at the MP joint.
After this was performed, after placing a clamp under the tendon, the tendon had full excursion, and the IP joint flexed fully.
Tourniquet was taken down. There was no active bleeding. All other
bleeding was stopped using bipolar. The wound was closed with 4-0 nylon sutures.
A sterile dressing was placed, and patient was taken to recovery room in stable
condition.