CMC Arthroplasty Question


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Good morning! We've had a little back and forth going on in my office regarding a patient's surgery. The doctor wants us to bill 25447 along with 20650 for insertion of the k-wire. Based on the documentation/abstract (below) he had gone in intending to do a LRTI procedure (25447) but after excising the trapezium, it was determine that the joint was stable enough to not require the full tendon transfer or ligament reconstruction.

I personally feel that the code billed should not be 25447 since the interposition and reconstruction was not performed, rather I feel we should just be billed the carpectomy and pin charge.

Can anyone take a look and tell me what you think?

Thank you!

"A #15 blade scalpel was used to make the incision that was previously marked and careful dissection was carried down through the subcutaneous tissues using littler scissors and the Adson forceps, being extremely careful to preserve the sensory nerve immediately adjacent. The sensory nerve was identified and surrounded with an operative stay-stitch loosely to hold it out of the operative field. The dissection was then carried down through the joint capsule, going between the extensor tendons of the thumb. This was done with a #69 Beaver blade, being careful to preserve the tendon structures and the capsule for later repair. The capsule was elevated exposing the CMC joing of the thumb and elevated off the trapezium. The trapezium was exposed in it's entirety and the tissue surrounding it was freed using a #69 beaver blade and littler scissors, being extremely careful to preserve the neurovascular structures in the area including the radial artery which was identified and visualized. The entire trapezium was excised from the patient's wrist using rongeur forceps. The would was irrigated with copious amounts of normal saline and inspected. At this point, it was determined that the joint was stable enough not to require an LRTI reconstruction secondary to minimal collapse of the metacarpal with manual manipulation. It was decided at this point to proceed with a k-wire stabilization procedure instead and forego an LRTI reconstruction.

A K-wire consisting of a 0.45 k-wire was advanced through the base of the thumb metacarpal into the base of the index finger metacarpal using direct visualization with intra-operative fluoroscopy. The metacarpal was elevated to its normal anatomical height and fixated using the temporary k-wire. The k-wire was positioned appropriately as well as the height of the metacarpal. The k-wire was then trimmed off above the skin and bent around in a hook. The wound was again irrigated with saline and the joint capsule was closed with interrupted 4-0 monocryl suture in a figure of 8 fashion."

Any help is greatly appreciated!