Help with op report - What CPT code?


Merrill, WI
Best answers
What CPT code?

In the usual fashion, a bayonet shaped incision was made over the proximal
first metacarpal, angling volarly and then proximally along the extensor
brevis and abductor longus tendons. The incision was carried down through
the dermis. Blunt spreading was used to carry directly down to the joint
capsule. The gap between the abductor and extensor was used. Any
neurovascular structures were retracted. The radial artery was identified in
the proximal end of the wound and was retracted dorsally.

An incision was made in the dorsal radial aspect of the trapezium metacarpal
joint. An incision was then carried directly down over the trapezium down to
the scaphotrapezial joint. Dissection was carried down onto bone and the
joint capsule was elevated, along with the periosteum off the dorsal radial
aspect of the joint. The joint capsule was tagged for later reattachment.

The trapezium was identified and was removed piecemeal. Notably, the distal
surface was polished, eburnated bone.

After the completion of the resection of the trapezium, the flexor carpi
radialis tendon was easily visualized in the depth of the wound.

Two transverse incisions were made, one proximally, one distally over the
tendon. The tendon was transected. It was grasped in the depths of the
wounds and brought out the dorsal radial wound.

The base of the metacarpal was then resected using the saw, keeping the piece
very thin. A drill was then used to make a hole in the dorsal radial aspect
of the thumb metacarpal, connected to a second hole in the base of the
metacarpal. These were connected using an awl. The tendon was then passed
through this, and holding the metacarpal in an abducted position with an
ulnar stress in the base, this was tightened down, and the tendon was sutured
back on itself, holding some pressure. This was done using two 2-0 grasping
sutures. The remainder of the tendon was then balled up in an anchovy
fashion and placed into the space created by the resection of the trapezium.

The tendon was sutured to the periosteum and the joint capsule of the thumb
metacarpal, and then the joint capsule was closed over the balled up tendon.
Very interesting, I just happened to be reading an OP note that sounds very similar....look at codes 25447 and 25110-59; my surgeon coded this himself and is very good at coding. If nothing else can give you somewhere to start hopefully.

I agree, its also called a basal thumb arthroplasty, however for the second code, I may lean towards the 25310 for the transfer of the tendon opposed to just the incision of the tendon.