pchamp25
Networker
- Messages
- 55
- Location
- New Durham, NH
There's a conflict between the professional and technical coding for this procedure. Provider performed a L hand Dupuytren's excision where the A1 pulleys of both the SF and RF were released but only the SF PIP joint was released so I feel this should only be coded with 26123 but since the A1 pulley was released on the RF as well, does that support 26125? Pre/Post OP dx code is M72.0
Operative Note
Pt was brought to the operating room. After IV sedation, time out and IV antibiotics were administered the patient's LUE was prepped and draped in usual sterile fashion. The limb was exsanguinated with an Esmarch and tourniquet raised to 250 mm Hg placed around the proximal arm. Palmar incision was mapped out along the prominent palmar cord extending to the SF P2. Soft tissue dissection was performed to separate the diseased palmar fascia from the surround tissues. Partial palmar fasciectomy of the fascia to the small finger was removed and sent to pathology. A1 pulleys of both SF and RF were released. Digital nerves both radial and ulnar to the small and ring finger were found and protected. The SF PIP joint was released to allow for full correction after Manipulation of the PIP joint under anesthesia (MUA). The wounds were irrigated, the tourniquet released and after 8 min to allow localized clotting, the wound was explored and small vessels were cauterized with bipolar. Z plasty performed at the SF MCP joint flexion crease. The wound was closed with 5-0 Prolene and a compressive dressing was applied. The capillary refill to all 5 digits was less than 2 sec and the skin flaps were well vascularized. The patient emerged from anesthesia without complications and taken to PACU in stable condition.
Any help would be appreciated!
Operative Note
Pt was brought to the operating room. After IV sedation, time out and IV antibiotics were administered the patient's LUE was prepped and draped in usual sterile fashion. The limb was exsanguinated with an Esmarch and tourniquet raised to 250 mm Hg placed around the proximal arm. Palmar incision was mapped out along the prominent palmar cord extending to the SF P2. Soft tissue dissection was performed to separate the diseased palmar fascia from the surround tissues. Partial palmar fasciectomy of the fascia to the small finger was removed and sent to pathology. A1 pulleys of both SF and RF were released. Digital nerves both radial and ulnar to the small and ring finger were found and protected. The SF PIP joint was released to allow for full correction after Manipulation of the PIP joint under anesthesia (MUA). The wounds were irrigated, the tourniquet released and after 8 min to allow localized clotting, the wound was explored and small vessels were cauterized with bipolar. Z plasty performed at the SF MCP joint flexion crease. The wound was closed with 5-0 Prolene and a compressive dressing was applied. The capillary refill to all 5 digits was less than 2 sec and the skin flaps were well vascularized. The patient emerged from anesthesia without complications and taken to PACU in stable condition.
Any help would be appreciated!