kmuth
Contributor
My doc wants me to bill for the trigger finger portion and the nodule excision, but I feel like the nodule was incidental? Am I incorrect?
Preoperative diagnosis: Right long trigger finger Dupuytren's nodule
Postoperative diagnosis: Right long trigger finger Dupuytren's nodule
Operation performed: Right long trigger finger release excision of Dupuytren's nodule right palm
Anesthesia: Local MAC
Indications: Patient is a 77-year-old female presents at this time with triggering of the right long finger. The patient has failed medical management. I went over the procedure with the patient and discussed the risks and benefits of the procedure with the patient. I have discussed the complications including but not limited to persistent triggering, numbness, persistent pain, infection, and bleeding. The patient was given an opportunity to ask questions and all those questions have been answered to the patient's satisfaction. The patient agrees to the procedure.
Procedure: Patient was taken to the operating room on 10/20/20 where her forearm, arm, and hand were first prepped and draped in the normal sterile fashion. Next I performed a metacarpal block anesthetic using 1% lidocaine and 0.5% Marcaine. Next the arm was elevated exsanguinated with an Esmarch bandage and a tourniquet inflated to 250 mmHg. Next an incision was made over the A1 pulley of the [default value ]a 15 blade. Because of the underlying Dupuytren's nodule I made a Z-shaped incision. I then used a Beaver blade to elevate skin flaps over the Dupuytren's nodule. I then removed the Dupuytren's nodule taking care not to injure the underlying nerves Next pickups and tenotomy scissors were used to dissect down to the A1 pulley of the digit. Care was taken not to injure the digital nerves. Next I divided the A1 pulley right down the middle and removed a small portion of the A1 pulley on either side of the incision that I had made in the A1 pulley. Next I freed up some of the fascial attachments proximal to the A1 pulley that sometimes serve as a secondary source of triggering. Next I retrieved the flexor tendons through the wound with Ragnell retractors. I then flexed and extended the PIP and DIP joints of the affected digit while looking at the proximal portion of the A2 pulley to make sure there was no residual triggering. I then irrigated the wound with copious amount of saline and closed the incision with a running 5-0 nylon modified horizontal mattress suture. I then released the tourniquet and made sure no hematoma developed. The wound was dressed with Adaptic ointment and a bulky soft bandage. The patient tolerated the procedure well and was sent to the postanesthesia care unit in stable condition.
Preoperative diagnosis: Right long trigger finger Dupuytren's nodule
Postoperative diagnosis: Right long trigger finger Dupuytren's nodule
Operation performed: Right long trigger finger release excision of Dupuytren's nodule right palm
Anesthesia: Local MAC
Indications: Patient is a 77-year-old female presents at this time with triggering of the right long finger. The patient has failed medical management. I went over the procedure with the patient and discussed the risks and benefits of the procedure with the patient. I have discussed the complications including but not limited to persistent triggering, numbness, persistent pain, infection, and bleeding. The patient was given an opportunity to ask questions and all those questions have been answered to the patient's satisfaction. The patient agrees to the procedure.
Procedure: Patient was taken to the operating room on 10/20/20 where her forearm, arm, and hand were first prepped and draped in the normal sterile fashion. Next I performed a metacarpal block anesthetic using 1% lidocaine and 0.5% Marcaine. Next the arm was elevated exsanguinated with an Esmarch bandage and a tourniquet inflated to 250 mmHg. Next an incision was made over the A1 pulley of the [default value ]a 15 blade. Because of the underlying Dupuytren's nodule I made a Z-shaped incision. I then used a Beaver blade to elevate skin flaps over the Dupuytren's nodule. I then removed the Dupuytren's nodule taking care not to injure the underlying nerves Next pickups and tenotomy scissors were used to dissect down to the A1 pulley of the digit. Care was taken not to injure the digital nerves. Next I divided the A1 pulley right down the middle and removed a small portion of the A1 pulley on either side of the incision that I had made in the A1 pulley. Next I freed up some of the fascial attachments proximal to the A1 pulley that sometimes serve as a secondary source of triggering. Next I retrieved the flexor tendons through the wound with Ragnell retractors. I then flexed and extended the PIP and DIP joints of the affected digit while looking at the proximal portion of the A2 pulley to make sure there was no residual triggering. I then irrigated the wound with copious amount of saline and closed the incision with a running 5-0 nylon modified horizontal mattress suture. I then released the tourniquet and made sure no hematoma developed. The wound was dressed with Adaptic ointment and a bulky soft bandage. The patient tolerated the procedure well and was sent to the postanesthesia care unit in stable condition.