Wiki Hand surgery question

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AKDunbar

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Hello everyone,

I am in need of your help.

Hand surgery is a struggle for me. I find it difficult but I get them billed and they have been getting thus far, so I guess I am not messing up as badly as I think. However, I have this particular surgery that has me stumped and I am seeking your assistance on the proper codes to bill. Thanks in advance for your help.

Procedures performed:
1 - Extensor tenolysis of the small finger.
2 - Flexor tenolysis of the small finger.
3- Capsular release, small finger, PIP joint.
4 - Release of palmar plate of the proximal interphalangeal joint of the small finger.
5 - Flexor tenolysis of the ring finger.
6 - Capsular release of the proximal interphalangeal joint of the ring finger.
7 - Release of the palmar plate of the proximal interphalangeal joint of the ring finger.
 
We would need more than a procedure list to help out. Need to know the diagnoses and body of report with descriptions of what was done. Does the patient have a contracture, if so what is it due to? Was there a traumatic injury and now they have contractures? Is there an underlying disease? I've sometimes seen this type procedure list for complicated rheumatoid cases. In this one there are four things going on with the small finger and three with the ring, so there could be bundling and other issues that come into it. Interestingly, none of these in the list say right or left. It may be somewhere else in the note but it's better if it is in the procedure header too.

I'm sure there may be other learning tools, but these two are really helpful and I think you could probably benefit if you are coding hand/wrist cases a lot. They can be really complicated and there are a lot of nuances to it. You need a really good, firm grasp of anatomy.

I would also just caution, just because a claim is getting paid doesn't necessarily mean the coding was correct. Not saying yours wasn't but that's not really a good indicator to go by. Do you have any other seasoned hand coders you can run things by? Does anyone audit your work routinely, especially if learning?

Some resources:
 
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