Carsil864
Contributor
Surgeon performed a partial trapeziectomy and a partial trapezoidecomy - would you code 25210 twice? Or should I just code the arthroplasty? Thank you!
POSTOPERATIVE DIAGNOSIS: Degenerative osteoarthritis, thumb Scaphotrapezial-trapezoid joint, RIGHT HAND.
PROCEDURE: Excisional arthroplasty RIGHT S-T-T joint with Partial trapeziectomy and partial trapezoidectomy
OPERATION: Excision carpal bone, partial trapeziectomy
CPT 25210
OPERATION: Excision carpal bone, partial trapezoidectomy
CPT 25210
INTRAOPERATIVE FINDINGS: The scaphotrapezio-trapezoid joint was inspected and found to have substantial arthritis with eburnation of the distal pole of the scaphoid as well as the two facing surfaces of the proximal trapezium and proximal trapezoid. There was eburnation completely to bone with no remaining cartilage evident on either surface.
DESCRIPTION OF PROCEDURE: After having achieved satisfactory regional anesthesia, converted and augmented with IV sedation and an LMA, with the patient in the supine position on the operating table, the RIGHT upper extremity was prepped and draped in the usual sterile fashion. The limb was exsanguinated with an esmark bandage and pneumatic tourniquet inflated to 225mmHG.
A modified Wagner incision was made over the axis of the thumb at the junction of the glabrous and hair bearing skin, with a perpendicular extension of the incision dorsally in the direction of the radial artery pulse in the anatomic snuffbox. Modest skin flaps were elevated, the radial sensory nerve branches were identified and protected throughout the case, and the radial artery was identified and mobilized dorsally to expose the trapeziometacarpal joint. Dorsal penetrating branches of the artery were cauterized and divided. The first extensor compartment tendons were identified and retracted volarly to exposed the scaphotrapezial and trapeziometacarpal joints.
A longitudinal incision was made along the axis of the thumb from the middle of the trapezium onto the distal pole of the scaphoid, across the scaphotrapezial joint, and full thickness radial and ulnar capsular flaps were sharply raised. With traction on the thumb, the S-T joint was identified and exposed dorsally to the trapezial-trapezoid joint. Osteophytes were noted along the dorsal ridge of the distal pole of the scaphoid.
The scaphotrapezial joint was distracted and inspected at this time and found to be with advanced arthritic change, as was the distal pole of the scaphoid. A 1cm osteotome was then used to cut the proximal half of the trapezium through 90% of the bone; the volar cortex was then fractured manually with manipulation of the osteotome to complete the fracture. Thereby, the proximal half of the trapezium was mobilized and removed without difficulty.
This exposed the Scaphotrapezoid joint which was in turn distracted and inspected. It was also found to contain advanced arthritic changes. Accordingly, an osteotome was similarly used to resect the proximal half of the trapezoid, again while carefully protecting the radial artery.
When removed, both surfaced of the resected trapezium and trapezoid were noted to be eburnated to bone with no residual cartilage. Similar changes of eburnation were noted on the distal pole of the scaphoid, which was then decompressed and perforated with several small holes using a 0.045 K-wire on a power drill.
POSTOPERATIVE DIAGNOSIS: Degenerative osteoarthritis, thumb Scaphotrapezial-trapezoid joint, RIGHT HAND.
PROCEDURE: Excisional arthroplasty RIGHT S-T-T joint with Partial trapeziectomy and partial trapezoidectomy
OPERATION: Excision carpal bone, partial trapeziectomy
CPT 25210
OPERATION: Excision carpal bone, partial trapezoidectomy
CPT 25210
INTRAOPERATIVE FINDINGS: The scaphotrapezio-trapezoid joint was inspected and found to have substantial arthritis with eburnation of the distal pole of the scaphoid as well as the two facing surfaces of the proximal trapezium and proximal trapezoid. There was eburnation completely to bone with no remaining cartilage evident on either surface.
DESCRIPTION OF PROCEDURE: After having achieved satisfactory regional anesthesia, converted and augmented with IV sedation and an LMA, with the patient in the supine position on the operating table, the RIGHT upper extremity was prepped and draped in the usual sterile fashion. The limb was exsanguinated with an esmark bandage and pneumatic tourniquet inflated to 225mmHG.
A modified Wagner incision was made over the axis of the thumb at the junction of the glabrous and hair bearing skin, with a perpendicular extension of the incision dorsally in the direction of the radial artery pulse in the anatomic snuffbox. Modest skin flaps were elevated, the radial sensory nerve branches were identified and protected throughout the case, and the radial artery was identified and mobilized dorsally to expose the trapeziometacarpal joint. Dorsal penetrating branches of the artery were cauterized and divided. The first extensor compartment tendons were identified and retracted volarly to exposed the scaphotrapezial and trapeziometacarpal joints.
A longitudinal incision was made along the axis of the thumb from the middle of the trapezium onto the distal pole of the scaphoid, across the scaphotrapezial joint, and full thickness radial and ulnar capsular flaps were sharply raised. With traction on the thumb, the S-T joint was identified and exposed dorsally to the trapezial-trapezoid joint. Osteophytes were noted along the dorsal ridge of the distal pole of the scaphoid.
The scaphotrapezial joint was distracted and inspected at this time and found to be with advanced arthritic change, as was the distal pole of the scaphoid. A 1cm osteotome was then used to cut the proximal half of the trapezium through 90% of the bone; the volar cortex was then fractured manually with manipulation of the osteotome to complete the fracture. Thereby, the proximal half of the trapezium was mobilized and removed without difficulty.
This exposed the Scaphotrapezoid joint which was in turn distracted and inspected. It was also found to contain advanced arthritic changes. Accordingly, an osteotome was similarly used to resect the proximal half of the trapezoid, again while carefully protecting the radial artery.
When removed, both surfaced of the resected trapezium and trapezoid were noted to be eburnated to bone with no residual cartilage. Similar changes of eburnation were noted on the distal pole of the scaphoid, which was then decompressed and perforated with several small holes using a 0.045 K-wire on a power drill.