Would CPT 64831 or 64999 be appropriate to bill for a Right index finger radial digital nerve repair with Nerve Tape? The CPT description states suture of digital nerve. The operative report does not describe the use of a suture, and the description of the nerve tap on the company website states “By eliminating sutures, Nerve Tape reduces repair time and minimizes tissue damage, enhancing surgical efficiency and improving the quality of nerve repair”
POSTOPERATIVE DIAGNOSES: Right index finger laceration, with flexor tendon and digital nerve laceration zone II.
OPERATIONS PERFORMED: 1. Right index finger flexor digitorum superficialis repair at insertion.2. Right flexor digitorum profundus repair.3. Right index finger radial digital nerve repair with Nerve Tape.
She was then transported to the OR. She remained in the supine position on the gurney. She underwent administration of IV sedation. Once adequate sedation had been obtained, the right upper extremity was prepped and draped. The upper arm tourniquet was applied, and the hand table was attached to the operative side of the gurney. I exsanguinated the extremity and inflated the tourniquet to 250 mmHg. I extended the original laceration proximally and distally exposing the flexor tendon sheath. There was absence of the FDS and FDP tendon within the tendon sheath. I visualized the radial digital nerve, which was 75-80% lacerated. I then retrieved the FDS and FDP tendons proximally, brought them into the wound, and pinned in position with the hypodermic needle. The FDS tendon had been severed just 2-3 mm proximal to the insertion of the slips into the middle phalanx. I repaired these using a 4-0 FiberWire and then augmented my repair by placing an Arthrex nano corkscrew into the middle phalanx at the insertion point of the FDS tendon. I used the sutures from the suture anchor and secured and augmented my repair by weaving the sutures from the suture anchor further up into the tendon to get further from the zone of injury and secured my repair of that tendon. After repairing the FDS tendon, I turned my attention to the FDP tendon. This was brought down into the wound and reapproximated with its distal portion. I used a 4-0 FiberLoop and performed a 6-stranded core suture repair as described by TFAI. After the 6-stranded repair, I brought the digit through the passive range of motion. There was no gapping at the repair sites of either tendon.
I next turned my attention to the digital nerves. Microdissection was performed using micro instruments. I then used the 2-mm nerve tape to reapproximate the nerve endings, and I wrapped the nerve with the nerve tape. There was good reapproximation of the nerve ends. I irrigated the wound. I closed the incision using a 5-0 nylon. I washed and dried the extremity. I applied dressing of Xeroform, sterile 4x4's, sterile Webril, and a dorsal block splint overwrapped with an Ace bandage. All digits were pink and viable at the conclusion. The patient was taken to the recovery room. She arrived in the recovery room in stable condition still under the influence of IV sedation. All counts were correct x2.
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POSTOPERATIVE DIAGNOSES: Right index finger laceration, with flexor tendon and digital nerve laceration zone II.
OPERATIONS PERFORMED: 1. Right index finger flexor digitorum superficialis repair at insertion.2. Right flexor digitorum profundus repair.3. Right index finger radial digital nerve repair with Nerve Tape.
She was then transported to the OR. She remained in the supine position on the gurney. She underwent administration of IV sedation. Once adequate sedation had been obtained, the right upper extremity was prepped and draped. The upper arm tourniquet was applied, and the hand table was attached to the operative side of the gurney. I exsanguinated the extremity and inflated the tourniquet to 250 mmHg. I extended the original laceration proximally and distally exposing the flexor tendon sheath. There was absence of the FDS and FDP tendon within the tendon sheath. I visualized the radial digital nerve, which was 75-80% lacerated. I then retrieved the FDS and FDP tendons proximally, brought them into the wound, and pinned in position with the hypodermic needle. The FDS tendon had been severed just 2-3 mm proximal to the insertion of the slips into the middle phalanx. I repaired these using a 4-0 FiberWire and then augmented my repair by placing an Arthrex nano corkscrew into the middle phalanx at the insertion point of the FDS tendon. I used the sutures from the suture anchor and secured and augmented my repair by weaving the sutures from the suture anchor further up into the tendon to get further from the zone of injury and secured my repair of that tendon. After repairing the FDS tendon, I turned my attention to the FDP tendon. This was brought down into the wound and reapproximated with its distal portion. I used a 4-0 FiberLoop and performed a 6-stranded core suture repair as described by TFAI. After the 6-stranded repair, I brought the digit through the passive range of motion. There was no gapping at the repair sites of either tendon.
I next turned my attention to the digital nerves. Microdissection was performed using micro instruments. I then used the 2-mm nerve tape to reapproximate the nerve endings, and I wrapped the nerve with the nerve tape. There was good reapproximation of the nerve ends. I irrigated the wound. I closed the incision using a 5-0 nylon. I washed and dried the extremity. I applied dressing of Xeroform, sterile 4x4's, sterile Webril, and a dorsal block splint overwrapped with an Ace bandage. All digits were pink and viable at the conclusion. The patient was taken to the recovery room. She arrived in the recovery room in stable condition still under the influence of IV sedation. All counts were correct x2.
Thank you for any feedback you are able to offer!