Question Finger Capsulotomy/ Tenolysis

kmuth

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Rothbury, MI
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I don't like hand coding and would love any webinar recommendations, or just general reading information to help me dive deeper. This doc tends to lack details/ dictation but when queried he doesn't respond or will say don't bill it. With this surgery I just don't think there is enough details to support billing the capsulotomy and tenolysis like he wants. He asked me to bill 26525 and 26445.

Preoperative diagnosis: Left small finger PIP joint and MP joint stiffness
Postoperative diagnosis: Same
Operation performed: Capsulotomy left small finger MP joint and PIP joints, tenolysis extensor tendons left small finger
Anesthesia: Supraclavicular block with general

Indications: Stiffness left small finger after fracture

Procedure: Patient was taken the operative on 08/04/20 where she was first given a supraclavicular block anesthetic. Next her forearm, arm, and hand were prepped and draped in normal sterile fashion. Next her arm was elevated exsanguinated with an Esmarch bandage and tourniquet inflated to 250 mmHg. Next an incision was made over the mid dorsal aspect of the left small finger with a 15 blade. Next skin flaps were elevated radially and ulnarly above the extensor tendon. The extensor tendon was stuck to the skin particularly around the base of the proximal phalanx where the fracture was previously located. I freed up the tendon from the surrounding tissue. I then split the extensor tendon down the middle using a Beaver blade and freed the tendon from the underlying bone. This is particularly sticky in the base of the proximal phalanx where the fracture had healed. I then flexed the MP joint and I got good flexion of that joint. For the PIP joint I then did the split tendon distally to the base of the middle phalanx and used a Beaver blade to partially take down the collateral ligaments from the head of the proximal phalanx. Once doing this I could get good flexion of the PIP joint. I then irrigated the wound with copious amounts of saline and repaired the tendon with a running 4-0 Vicryl suture. I then repaired the skin with running 5 and on modified Arzola mattress suture. The patient was then placed in a bulky soft bandage. She tolerated procedure well with discharge the postop area and will be seen tomorrow to begin physical therapy.
 
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