kmuth
Contributor
Here is my question I know I can code 26123-F5 but through out the op note he is also dissecting the left ring finger which he also says is involved but he did not state the left ring finger in the operation performed/ postop diagnosis. Can I bill 26123-F5 and 26125-F4 or just 26123?
PREOPERATIVE DIAGNOSIS:
Dupuytren disease with metatarsophalangeal joint and proximal interphalangeal
joint contractures, left small finger.
POSTOPERATIVE DIAGNOSIS:
Dupuytren disease with metatarsophalangeal joint and proximal interphalangeal
joint contractures, left small finger.
OPERATIONS PERFORMED:
1. Partial palmar fasciectomy, left hand.
2. Digital fasciectomy, left small finger with proximal interphalangeal and
metatarsophalangeal joint contracture releases.
ANESTHESIA:
Block with general.
INDICATION:
Patient is a 59-year-old male who presents with fixed fibrous Dupuytren disease
affecting the MP joint of his left ring and small finger as well as the PIP
joint of his left small finger. He has significant pretendinous and spiral
cords contributing to the correct contractures.
PROCEDURE IN DETAIL:
Patient was taken to the operating room on 07/30/2020 where he was given a
general block anesthetic. Next, his forearm, arm, and hand were prepped and
draped in normal sterile fashion. Next, his arm was elevated, exsanguinated
with an Esmarch bandage and tourniquet inflated to 250 mmHg. Next, incisions
were outlined extending from the mid palm just past the DIP flexion crease of
the left small finger. I then very carefully elevated skin flaps radially and
ulnarly to elevate the skin, thick enough to provide vascularity, but thin
enough to remove as much disease as possible. The skin flaps were elevated
with care and 4-0 nylon were used as retention sutures. I identified the
pretendinous cords of the ring and small fingers, which were both involved. I
dissected these free and then transected the cords at the mid palm and then
traced them from proximal to distal. I split the cord so that would be used to
dissect them. I preserved the transverse fibers of the superficial palmar
fascia to the ring finger to keep the neurovascular structures deep, but on the
small finger I did sacrifice the transverse fibers as they were intimately
associated with the longitudinal fibers. I located all nerves including the
common digital nerve to the 3rd and 4th web spaces and the proper digital
nerves to the small finger and the ulnar side of the ring finger. I then
proceeded to dissect the diseased fascia, which was very thick and fibrous
particularly just distal to the proximal digital crease of the small finger, it
was tedious. The natatory cord was also involved and this was excised. This
was causing a web space contracture between the ring and small. That was
excised along with the pretendinous cords and spiral cord. The radial digital
nerve to the small finger was intimately associated with the diseased almost
forming I could not pass through the diseased tissue making its dissection
rather difficult, but all nerves and arteries were preserved throughout the
entire operation. Once I had the cord removed, I was able to fully straighten
the MP joint and the PIP joint. I then rearranged the skin slightly with
Z-plasty to facilitate closure and try to prevent subsequent scar contracture.
I then irrigated the wound with copious amounts of saline. I irrigated the
wound with copious amounts of saline and closed the skin with running 5-0 nylon
and interrupted 5-0 nylon modified horizontal mattress sutures. I then
released the tourniquet. The patient was placed in a dressing and splint. He
tolerated the procedure well and sent to discharge area. Specimen was
Dupuytren cords. Total tourniquet time was 1 hour 16 minutes.
PREOPERATIVE DIAGNOSIS:
Dupuytren disease with metatarsophalangeal joint and proximal interphalangeal
joint contractures, left small finger.
POSTOPERATIVE DIAGNOSIS:
Dupuytren disease with metatarsophalangeal joint and proximal interphalangeal
joint contractures, left small finger.
OPERATIONS PERFORMED:
1. Partial palmar fasciectomy, left hand.
2. Digital fasciectomy, left small finger with proximal interphalangeal and
metatarsophalangeal joint contracture releases.
ANESTHESIA:
Block with general.
INDICATION:
Patient is a 59-year-old male who presents with fixed fibrous Dupuytren disease
affecting the MP joint of his left ring and small finger as well as the PIP
joint of his left small finger. He has significant pretendinous and spiral
cords contributing to the correct contractures.
PROCEDURE IN DETAIL:
Patient was taken to the operating room on 07/30/2020 where he was given a
general block anesthetic. Next, his forearm, arm, and hand were prepped and
draped in normal sterile fashion. Next, his arm was elevated, exsanguinated
with an Esmarch bandage and tourniquet inflated to 250 mmHg. Next, incisions
were outlined extending from the mid palm just past the DIP flexion crease of
the left small finger. I then very carefully elevated skin flaps radially and
ulnarly to elevate the skin, thick enough to provide vascularity, but thin
enough to remove as much disease as possible. The skin flaps were elevated
with care and 4-0 nylon were used as retention sutures. I identified the
pretendinous cords of the ring and small fingers, which were both involved. I
dissected these free and then transected the cords at the mid palm and then
traced them from proximal to distal. I split the cord so that would be used to
dissect them. I preserved the transverse fibers of the superficial palmar
fascia to the ring finger to keep the neurovascular structures deep, but on the
small finger I did sacrifice the transverse fibers as they were intimately
associated with the longitudinal fibers. I located all nerves including the
common digital nerve to the 3rd and 4th web spaces and the proper digital
nerves to the small finger and the ulnar side of the ring finger. I then
proceeded to dissect the diseased fascia, which was very thick and fibrous
particularly just distal to the proximal digital crease of the small finger, it
was tedious. The natatory cord was also involved and this was excised. This
was causing a web space contracture between the ring and small. That was
excised along with the pretendinous cords and spiral cord. The radial digital
nerve to the small finger was intimately associated with the diseased almost
forming I could not pass through the diseased tissue making its dissection
rather difficult, but all nerves and arteries were preserved throughout the
entire operation. Once I had the cord removed, I was able to fully straighten
the MP joint and the PIP joint. I then rearranged the skin slightly with
Z-plasty to facilitate closure and try to prevent subsequent scar contracture.
I then irrigated the wound with copious amounts of saline. I irrigated the
wound with copious amounts of saline and closed the skin with running 5-0 nylon
and interrupted 5-0 nylon modified horizontal mattress sutures. I then
released the tourniquet. The patient was placed in a dressing and splint. He
tolerated the procedure well and sent to discharge area. Specimen was
Dupuytren cords. Total tourniquet time was 1 hour 16 minutes.