Wiki left thumb metacarpophalgeal arthrodesis & trapezium excision w/ suture suspension


Waco, TX
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left thumb metacarpophalgeal arthrodesis & trapezium excision w/ suture suspension

I need help coding this surgery for accuracy and maximum reimbursement. Should I use 25320, 25210, and 26850 or 25447?

The skin was incised with a 15 blade along the preplanned mark. Hemostasis was achieved where indicated with electrocautery. Dissection continued in blunt and sharp fashion with tenotomy scissors to expose the tendons. The periosteum at the base of the thumb was incised longitudinally as well as the joint capsule, then the trapezium was circumferentially dissected and removed.
Through a separate interval, the metacarpophalangeal joint was opened, dissected free, and shot-gunned open. The guidewire for the metacarpal post was inserted. It was then over-reamed with the conical reamer. The post was then sized and inserted by hand.
The mini C-arm image intensifier was used during the procedure to assure appropriate positioning of guidewires and hardware, as well as complete removal of the trapezium.
With the post inserted, the palmar aspect of the metacarpal head was removed to place the guide wire, which was then able to make the dorsal window and plane out the surface of the metacarpal. The guidewire was then placed in the base of the proximal phalanx and overdrilled as well to make the matching mating surface.
The wounds were copiously irrigated. The post was measured and then screwed into place. Once this was secure, attention was turned back to the base of the thumb.
The guidewire for the Mini TightRope was advanced from the thumb to the second metacarpal base. Once it was in good position, the Mini TightRope was advanced across it as well. The second button was applied and then the suture was tied suspending the metacarpal.