I am looking for suggestions on how this surgery should be coded. We have been coding with 25332, Arthroplasty, wrist; however, provider is not happy that 25240, ulna excision, is included. Is there a better code we should be using?
POSTOPERATIVE DIAGNOSIS: Rheumatoid arthritis, right wrist.
PROCEDURE:
1. Excision of distal ulna
2. Proximal row carpectomy
3. Excision of posterior interosseous nerve
4. Interpositioned soft tissue arthroplasty of wrist
DESCRIPTION OF OPERATION: The patient was brought to the Operating Room. After satisfactory anesthesia was confirmed and IV antibiotics were administered, the right
upper extremity was prepped and draped in the usual sterile fashion. A longitudinal incision centered over the radial shaft and the middle finger ray was created, dissection
carried down to the extensor retinaculum, which was exposed, mobilizing full thickness skin flaps. The third dorsal compartment was incised and the EPL tendon was reflected.
The second and fourth dorsal compartments as well as the fifth dorsal compartments were elevated in a subcompartmental, but extracapsular fashion. The distal radioulnar joint
capsule was then incised longitudinally and the distal ulna was harvested using a high speed sagittal saw. The arthrtomy was then continued transversely across the wrist joint
in order to expose the proximal carpal row. This was excised sharply and also with piecemeal using the rongeur to get out the remainder of the scaphoid. At this point, it
was evident that the carpus would sit appropriately on the lunate facet despite the fact that there was significant volar tilt to the distal radius. The articular surfaces as
expected however were destroyed and so therefore an interposition arthroplasty was performed. This was performed by harvesting the proximal head of the capitate as well as
hamate and the dorsal capsule was sutured using multiple Monocryl sutures in between the capitate, hamate and the radius. This resulted in very nice interposition flap and good
position of the hand which would not require any subsequent pinning temporarily. At this point, the DREJ capsule was reapproximated with the distal ulna placed in a reduced
position and the retinaculum was reapproximated. The skin was closed in layers. A bulky dressing incorporating a sugar tong splint was applied. She tolerated the procedure well
and was transferred to the Recovery Room stable and without evidence of intraoperative complication.
POSTOPERATIVE DIAGNOSIS: Rheumatoid arthritis, right wrist.
PROCEDURE:
1. Excision of distal ulna
2. Proximal row carpectomy
3. Excision of posterior interosseous nerve
4. Interpositioned soft tissue arthroplasty of wrist
DESCRIPTION OF OPERATION: The patient was brought to the Operating Room. After satisfactory anesthesia was confirmed and IV antibiotics were administered, the right
upper extremity was prepped and draped in the usual sterile fashion. A longitudinal incision centered over the radial shaft and the middle finger ray was created, dissection
carried down to the extensor retinaculum, which was exposed, mobilizing full thickness skin flaps. The third dorsal compartment was incised and the EPL tendon was reflected.
The second and fourth dorsal compartments as well as the fifth dorsal compartments were elevated in a subcompartmental, but extracapsular fashion. The distal radioulnar joint
capsule was then incised longitudinally and the distal ulna was harvested using a high speed sagittal saw. The arthrtomy was then continued transversely across the wrist joint
in order to expose the proximal carpal row. This was excised sharply and also with piecemeal using the rongeur to get out the remainder of the scaphoid. At this point, it
was evident that the carpus would sit appropriately on the lunate facet despite the fact that there was significant volar tilt to the distal radius. The articular surfaces as
expected however were destroyed and so therefore an interposition arthroplasty was performed. This was performed by harvesting the proximal head of the capitate as well as
hamate and the dorsal capsule was sutured using multiple Monocryl sutures in between the capitate, hamate and the radius. This resulted in very nice interposition flap and good
position of the hand which would not require any subsequent pinning temporarily. At this point, the DREJ capsule was reapproximated with the distal ulna placed in a reduced
position and the retinaculum was reapproximated. The skin was closed in layers. A bulky dressing incorporating a sugar tong splint was applied. She tolerated the procedure well
and was transferred to the Recovery Room stable and without evidence of intraoperative complication.
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