Question complex finger laceration


Loveland, CO
Best answers
I'm looking for some advice on how to code this laceration repair one of my surgeons performed.
He did an open repair of right thumb extensor tendon laceration, irrigation and debridement of an open joint of the MCP joint, and capsular repair as well as complex closure of a laceration of about 10 cm.
I am looking at CPT 26418 for the extensor tendon repair. There are CCI edits for the open debridement and complex wound closure, so I am wondering if those would be inclusive to the 26418?

Here is the scrubbed version of the op note:
After exploring the wound itself, we noted that there was a large section of the tendon missing, probably about a 4 mm to 5 mm section. In addition, it was wide open to the joint itself of the MCP joint and the capsule was very ragged and irrigated and there was a lot of road rash around the area and sections were missing. One I was able to irrigate and debride this entire area and then remove loose fragments of asphalt, I was able to inspect the join and there were no other signs of problems. I repaired the joint capsule using a 3-0 Vicryl and interrupted stitches type fashion and then followed by a running stitch over the top of it. Once I was able to repair it, the capsule was okay to hold in place and we then explored the tendon. I was able to find the proximal aspect, which had retracted back quite a bit so we had to extend the laceration. I was then able to identify it and clean it off then get two ends that were amenable for repair. Unfortunately to do this, we had to extend the IP joint of the thumb quite a bit in order to get those together. We then irrigated again and then commence with repair.
I did this using a 4-0 Fiber Loop by making two sections with one starting proximal to distal and the other one starting distal to proximal. Once we had four core sutures across, I was then able to tie them over itself and then I was able to tie the sutures itself back into each other to create four more core sutures across the level of the extensor part of the tendon. This brought the two pieces of tendon together. I was able to flex and extend the IP joint slightly and did show good excursion of the tendon and movement associated and was not adherent to the underlying structures. I then irrigated again with copious amounts of saline and closed the skin with 4-0 Nylon in interrupted mattress type fashion. Unfortunately, it was a very stellate and complex laceration and required careful repair associated with this.

Any help with this would be greatly appreciated!

Sally Cookman, CPC, COSC