jenpollock
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One of my physicians performed the following procedure, and I was hoping you all can review and let me know if the codes I have are what you would use:
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ANESTHESIA:
General endotracheal.
PREOPERATIVE DIAGNOSES:
Left upper extremity: Fracture dislocation elbow, open radial
shaft fracture and open segmental ulnar shaft fracture with
significant bone loss secondary to loss at the time of accident,
3rd, 4th, and 5th metacarpal fractures, middle and ring
phalangeal fractures.
OPERATION PERFORMED:
Extensive wound debridement, multiple fractures, and
stabilization of multiple fractures with fluoroscopy.
DESCRIPTION OF OPERATION:
Following induction of anesthesia, a pneumatic tourniquet was
placed about the left upper arm. The left upper extremity was
carefully scrubbed with bone brushes and chlorhexidine. The
extremity was inspected. Chlorhexidine prep was used followed by
draping in the usual manner. The limb was ______ followed by
inflation of the tourniquet to 250 mmHg.
The forearm wounds were sharply debrided of the skin, fascia,
muscle, and bone fragments. It was apparent that the ulnar
segmental loss had occurred with an extrusion from the body
without loose bone fragments noted on x-ray. I elected to open
the radius and continue debridement deep into the tissues. Pulse
lavage was used. The radius was reduced and plated with a
satisfactory alignment, appearance, and stability. Change from
fluoroscopy to C-arm at that point confirming the close reduction
of the elbow dislocation. Number of fragments was present, but
the joints appeared concentric. The ulnar segmental defect was
noted. Wound had been debrided. No further treatment was
elected due to the findings.
Attention was then turned to the hand. The hand had multiple
areas of full thickness, skin injury, lacerations since
significant swelling of the dorsal and palmar aspects of the
hand. A grossly unstable fracture was present at the 3rd, 4th,
and 5th metacarpales and at the middle and the ring finger
phalanges to include intraarticular condylar disruption and a
transverse middle phalanx fracture.
To provide some stability of the hand, a dorsal incision was
placed overlying the third metacarpal and carried down to the
hemorrhagic tissue to the extensor mechanism. It was retracted
laterally exposing the metacarpal. The reduction was performed
keeping a segmental fragment in the wound with satisfactory
normal soft tissue connection. A small 7.0 plate was then
applied with overall satisfactory appearance and improved
stability including the ulnar metacarpals. K-wires were then
introduced in the arm and metacarpals for a degree of stability.
Attention was then turned to the phalanges. Again significant
soft tissue injuries were present. Multiple wounds were present.
Extensor tendon was disrupted and a portion of it was absent such
that primary repair was not possible overlying the condylar
fracture. Pins were placed as possible to obtain a degree of
stability. Considering soft tissue condition this was the
maximum that I felt was indicated at the time.
Skin was again cleansed. Wounds were not closed. Capsule placed
on the ______ pins. Kerlix roll was placed on the palm followed
by Telfa and Kerlix wrap. A posterior splint was applied from
fingertips up to the proximal arm. Anesthesia was discontinued.
The patient was extubated. The patient was transferred to PACU
in satisfactory condition.
*********************************************************
The CPT codes I have so far are:
11012
25515
24600
26615
26735
Any help would be GREATLY appreciated.
**********************************************************
ANESTHESIA:
General endotracheal.
PREOPERATIVE DIAGNOSES:
Left upper extremity: Fracture dislocation elbow, open radial
shaft fracture and open segmental ulnar shaft fracture with
significant bone loss secondary to loss at the time of accident,
3rd, 4th, and 5th metacarpal fractures, middle and ring
phalangeal fractures.
OPERATION PERFORMED:
Extensive wound debridement, multiple fractures, and
stabilization of multiple fractures with fluoroscopy.
DESCRIPTION OF OPERATION:
Following induction of anesthesia, a pneumatic tourniquet was
placed about the left upper arm. The left upper extremity was
carefully scrubbed with bone brushes and chlorhexidine. The
extremity was inspected. Chlorhexidine prep was used followed by
draping in the usual manner. The limb was ______ followed by
inflation of the tourniquet to 250 mmHg.
The forearm wounds were sharply debrided of the skin, fascia,
muscle, and bone fragments. It was apparent that the ulnar
segmental loss had occurred with an extrusion from the body
without loose bone fragments noted on x-ray. I elected to open
the radius and continue debridement deep into the tissues. Pulse
lavage was used. The radius was reduced and plated with a
satisfactory alignment, appearance, and stability. Change from
fluoroscopy to C-arm at that point confirming the close reduction
of the elbow dislocation. Number of fragments was present, but
the joints appeared concentric. The ulnar segmental defect was
noted. Wound had been debrided. No further treatment was
elected due to the findings.
Attention was then turned to the hand. The hand had multiple
areas of full thickness, skin injury, lacerations since
significant swelling of the dorsal and palmar aspects of the
hand. A grossly unstable fracture was present at the 3rd, 4th,
and 5th metacarpales and at the middle and the ring finger
phalanges to include intraarticular condylar disruption and a
transverse middle phalanx fracture.
To provide some stability of the hand, a dorsal incision was
placed overlying the third metacarpal and carried down to the
hemorrhagic tissue to the extensor mechanism. It was retracted
laterally exposing the metacarpal. The reduction was performed
keeping a segmental fragment in the wound with satisfactory
normal soft tissue connection. A small 7.0 plate was then
applied with overall satisfactory appearance and improved
stability including the ulnar metacarpals. K-wires were then
introduced in the arm and metacarpals for a degree of stability.
Attention was then turned to the phalanges. Again significant
soft tissue injuries were present. Multiple wounds were present.
Extensor tendon was disrupted and a portion of it was absent such
that primary repair was not possible overlying the condylar
fracture. Pins were placed as possible to obtain a degree of
stability. Considering soft tissue condition this was the
maximum that I felt was indicated at the time.
Skin was again cleansed. Wounds were not closed. Capsule placed
on the ______ pins. Kerlix roll was placed on the palm followed
by Telfa and Kerlix wrap. A posterior splint was applied from
fingertips up to the proximal arm. Anesthesia was discontinued.
The patient was extubated. The patient was transferred to PACU
in satisfactory condition.
*********************************************************
The CPT codes I have so far are:
11012
25515
24600
26615
26735
Any help would be GREATLY appreciated.