Wiki Cpt help! Epl epb tendon repair w/foreign body removal

codegirl0422

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Please help with CPT codes. I am new to trauma/ortho coding. Thanks in advance for any help.

PROCEDURE PERFORMED:
1. Repair of extensor pollicis longus.
2. Tendon repair of extensor pollicis brevis.
3. Removal of metallic foreign body from right thumb.
4. Irrigation and debridement down to the level of bone.

His thumb was then evaluated. His previous sutures were removed and the transverse laceration on the back of his thumb was extended both proximally and distally. Immediately once opening the wound there was obvious metallic foreign body that was removed. Quite surprisingly, there were numerous small metallic foreign bodies that were seen. Using careful dissection, rongeur pickups and irrigation all these metallic foreign bodies were removed. The extensor tendons to the EPL and EPB were clearly lacerated and retracted. They were easily found within thewound. They were retracted approximately 2 cm. After further investigation, there was a cortical defect in the metatarsal aspect of the metacarpal. There was some debris on top of the bone. This was curetted out and carefully removed. We thoroughly irrigated this bone. Once irrigated and there was no gross debris, using 4-0 Vicryl the periosteum over the bone was closed.

We then identified the tendon ends, carefully cleaned the hematoma that was on the end of the tendon, and started performing our tendon repair. Interesting enough, the EPL and EPB tendons came together and these were not completely separated. These combined together on the extensor overlying the MCP joint. Using four core suture technique with 3-0 Ethibond we placed a modified Kessler stitches on each of the tendon ends of the EPL and EPB. We were pleased with our tissue. We were able to easily approximate the tendon ends without tension on the repair.

The 3-0 Ethibond sutures were tied once again forming a four-strand core suture technique. We then performed an epitendinous suture using a running locking stitch using a 3-0 Ethibond as well. We were very pleased with our repair and our approximation of the tendon ends. At this point we irrigated the wounds once more and started our closure.

The laceration was closed with 4-0 nylon using simple and horizontal mattress-style suture. The resultant laceration was more of a zig-zag laceration on the dorsal aspect of his thumb. We then placed ropivacaine around the incision for postoperative pain control, Xeroform over the incision, and placed him in a thumb spica splint for immobilization of his thumb.
 
Is there anyone that can help on this one? is the foreign body removal and irrigation/debridement included? would I use the 1..... codes for foreign body removal since he doesn't mention joint? and the irr/deb code would I use 11044 since he went to the bone (he doesn't mention he went to tendon muscle etc)?
 
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