Would you use unlisted code (26989) for a Closed reduction and percutaneous pinning, right thumb carpometacarpal joint?
I do not have access to CPT assistant. I have looked at CPT 26650 however there is no mention of a fracture. CPT 26608 also states fracture, metacarpal. CPT 26641 closed treatment of carpometacarpal dislocation ( no specific code for the percutaneous treatment of carpometacarpal dislocation)
Clinical notes indicate the procedure was originally intended to be Open reduction pinning right thumb CMC joint
POSTOPERATIVE DIAGNOSIS: Right thumb carpometacarpal joint dislocation, recurrent.
OPERATION PERFORMED: Closed reduction and percutaneous pinning, right thumb carpometacarpal joint.
FINDINGS: Unstable right thumb CMC joint.
DESCRIPTION OF PROCEDURE: The patient was met in the holding area. The surgical site was marked and confirmed. Questions were answered. We then proceeded to the OR after placement of a regional block by anesthesia. Once in the OR, the patient underwent administration of IV sedation. The bed was rotated to allow better access to the right upper extremity. The forearm tourniquet was applied, and the extremity underwent prep and drape. After prep and drape, a time-out was performed. After routine time-out, I proceeded with the procedure. I exsanguinated the extremity with an Esmarch bandage and inflated the tourniquet to 250 mmHg. I then brought in fluoroscopy and placed longitudinal traction on the thumb and then applied force to the base of the thumb metacarpal allowing me to reduce the CMC joint. I then placed a 0.062 K[1]wire to the base of the thumb metacarpal and into the base of the index finger metacarpal holding good traction on that joint. I took the 0.054 K-wire and placed it into the thumb metacarpal base and across the CMC joint into the trapezium. There was good stability of the reduction and good reduction on fluoroscopy in multiple views. The pins were bent and cut. I applied dressings of Xeroform, sterile gauze, sterile Webril, and a thumb spica splint of plaster. The patient was then awakened and taken to the recovery room. He arrived in the recovery room in stable condition still under the influence of IV sedation. All counts were correct x2.
I do not have access to CPT assistant. I have looked at CPT 26650 however there is no mention of a fracture. CPT 26608 also states fracture, metacarpal. CPT 26641 closed treatment of carpometacarpal dislocation ( no specific code for the percutaneous treatment of carpometacarpal dislocation)
Clinical notes indicate the procedure was originally intended to be Open reduction pinning right thumb CMC joint
POSTOPERATIVE DIAGNOSIS: Right thumb carpometacarpal joint dislocation, recurrent.
OPERATION PERFORMED: Closed reduction and percutaneous pinning, right thumb carpometacarpal joint.
FINDINGS: Unstable right thumb CMC joint.
DESCRIPTION OF PROCEDURE: The patient was met in the holding area. The surgical site was marked and confirmed. Questions were answered. We then proceeded to the OR after placement of a regional block by anesthesia. Once in the OR, the patient underwent administration of IV sedation. The bed was rotated to allow better access to the right upper extremity. The forearm tourniquet was applied, and the extremity underwent prep and drape. After prep and drape, a time-out was performed. After routine time-out, I proceeded with the procedure. I exsanguinated the extremity with an Esmarch bandage and inflated the tourniquet to 250 mmHg. I then brought in fluoroscopy and placed longitudinal traction on the thumb and then applied force to the base of the thumb metacarpal allowing me to reduce the CMC joint. I then placed a 0.062 K[1]wire to the base of the thumb metacarpal and into the base of the index finger metacarpal holding good traction on that joint. I took the 0.054 K-wire and placed it into the thumb metacarpal base and across the CMC joint into the trapezium. There was good stability of the reduction and good reduction on fluoroscopy in multiple views. The pins were bent and cut. I applied dressings of Xeroform, sterile gauze, sterile Webril, and a thumb spica splint of plaster. The patient was then awakened and taken to the recovery room. He arrived in the recovery room in stable condition still under the influence of IV sedation. All counts were correct x2.