Looking for Hand Surgery Coding Resources for extensive hand and finger procedures.
Would like to see what CPT codes others come up with for the procedures below.
My codes CPT codes 26850, 25447 and 20926 for sure, I also looked at adding 25312 but it doesn’t feel right.
Reviewed with our team auditor she came up with 25447, 26516, 25310, 26480, but not sure I agree with her codes either.
DX -Thumb carpometacarpal osteoarthritis with hyperextension of the thumb metacarpophalangeal joint.
Procedures Performed:
1 -RT Thumb ligament reconstruction, tendon interposition, CMC joint
2 -RT one bone carpectomy, trapeziectomy
3 -Tendon transfer, RT wrist, dorsal RT APL to FCR
4 -Right first extensor compartment release
5 -RT thumb metacarpophalangeal joint volar capsulodesis with metacarpophalangeal joint pinning
First a Bruner incision volar to the metacarpophalangeal joint of the RT thumb. Sharpe dissection was carried to the level of subcutaneous tissue. Full-thickness flaps were lifted away from the flexor mechanism. I identified the radioulnar neurovascular bundles relative to the flexor sheath. I released 1 pulley, protected the oblique pulley and made a longitudinal incision in the palmar plate with cruciate extension again protecting neurovascular structures. I thoroughly irrigated this wound with sterile saline and turned my attention to the wrist.
Approximately 2 cm incision was made overly the thumb CMC, articulation and a 1.5 cm incision proximal to the first extensor retinaculum. Sharp dissection was carried down to the level of subcutaneous tissue at both incisions, identified the dorsal radial sensory branches at both incisions, Distally, I opened the dorsal capsule of the thumb metacarpophalangeal joint between the EPB and APL. A large volar slip of the APL was selected. I release the first extensor retinaculum (deQuervain’s release). The EPB was in a separate department, which was released. I released the most volar slip of the APL proximally, brought this distally into the wound.
A dorsally based arthrotomy was made at the thumb CMC, articulation taking care to protect dorsal branch of the radial sensory nerve and the dorsal division of the radial artery. The trapezium was identified and I performed the trapeziectomy using a rongeur and small osteotome. All marginal osteophytes were identified and excised. I recontoured the base of the thumb metacarpal removing osteophytes. I thoroughly irrigated this wound with sterile saline. Care has been taken to protect and preserve the FCR.
While holding the thumb in a position of functional palmar abduction, I performed a tendon weave APL to FCR. Stay suture had been placed within proximal migration of the tendon weave through the FCR. I then harvested the Palmaris through 3 longitudinal incisions in the proximal forearm and verified that was separate from the median nerve and palmar cutaneous branch of median nerve. The Palmaris was gathered in an accordion type fashion using a 3.0 TiCron and was place in saline for later use.
Attention was then turned back to the CMC articulation. The APL was rolled then back to itself and the base of the wound, again maintained palmar abduction of the thumb. I then took the Palmaris and sewed this to the APL, FCR interface as an interposition. I then brought the dorsal capsule back over the interposition and repaired it with 3.0 TiCron, figure of eight sutures taking care to protect dorsal neurovascular structures.
I had brought the APL as ulnar as possible through the dorsal capsule of the CMC articulation. Again, this was tensioned and the APL was sewn to the capsule with a horizontal mattress of 3.0 TiCron. I then wove the APL transferred stump back to the intact APL with 3 weaves using a Pulvertaft weave instrument, each was 9 degrees to the last and secured with a 3.0 TiCron horizontal mattress sutures.
I thoroughly irrigated all wounds with sterile saline.
Using the C-arm, I pinned the metacarpophalangeal joint in approximately 20 degrees of flexion in antegrade fashion using a 0.045 inch K-wire, which was bent and cut short. Fluoroscopy was used to verify pin position. The MP joint was stable after pinning.
Would like to see what CPT codes others come up with for the procedures below.
My codes CPT codes 26850, 25447 and 20926 for sure, I also looked at adding 25312 but it doesn’t feel right.
Reviewed with our team auditor she came up with 25447, 26516, 25310, 26480, but not sure I agree with her codes either.
DX -Thumb carpometacarpal osteoarthritis with hyperextension of the thumb metacarpophalangeal joint.
Procedures Performed:
1 -RT Thumb ligament reconstruction, tendon interposition, CMC joint
2 -RT one bone carpectomy, trapeziectomy
3 -Tendon transfer, RT wrist, dorsal RT APL to FCR
4 -Right first extensor compartment release
5 -RT thumb metacarpophalangeal joint volar capsulodesis with metacarpophalangeal joint pinning
First a Bruner incision volar to the metacarpophalangeal joint of the RT thumb. Sharpe dissection was carried to the level of subcutaneous tissue. Full-thickness flaps were lifted away from the flexor mechanism. I identified the radioulnar neurovascular bundles relative to the flexor sheath. I released 1 pulley, protected the oblique pulley and made a longitudinal incision in the palmar plate with cruciate extension again protecting neurovascular structures. I thoroughly irrigated this wound with sterile saline and turned my attention to the wrist.
Approximately 2 cm incision was made overly the thumb CMC, articulation and a 1.5 cm incision proximal to the first extensor retinaculum. Sharp dissection was carried down to the level of subcutaneous tissue at both incisions, identified the dorsal radial sensory branches at both incisions, Distally, I opened the dorsal capsule of the thumb metacarpophalangeal joint between the EPB and APL. A large volar slip of the APL was selected. I release the first extensor retinaculum (deQuervain’s release). The EPB was in a separate department, which was released. I released the most volar slip of the APL proximally, brought this distally into the wound.
A dorsally based arthrotomy was made at the thumb CMC, articulation taking care to protect dorsal branch of the radial sensory nerve and the dorsal division of the radial artery. The trapezium was identified and I performed the trapeziectomy using a rongeur and small osteotome. All marginal osteophytes were identified and excised. I recontoured the base of the thumb metacarpal removing osteophytes. I thoroughly irrigated this wound with sterile saline. Care has been taken to protect and preserve the FCR.
While holding the thumb in a position of functional palmar abduction, I performed a tendon weave APL to FCR. Stay suture had been placed within proximal migration of the tendon weave through the FCR. I then harvested the Palmaris through 3 longitudinal incisions in the proximal forearm and verified that was separate from the median nerve and palmar cutaneous branch of median nerve. The Palmaris was gathered in an accordion type fashion using a 3.0 TiCron and was place in saline for later use.
Attention was then turned back to the CMC articulation. The APL was rolled then back to itself and the base of the wound, again maintained palmar abduction of the thumb. I then took the Palmaris and sewed this to the APL, FCR interface as an interposition. I then brought the dorsal capsule back over the interposition and repaired it with 3.0 TiCron, figure of eight sutures taking care to protect dorsal neurovascular structures.
I had brought the APL as ulnar as possible through the dorsal capsule of the CMC articulation. Again, this was tensioned and the APL was sewn to the capsule with a horizontal mattress of 3.0 TiCron. I then wove the APL transferred stump back to the intact APL with 3 weaves using a Pulvertaft weave instrument, each was 9 degrees to the last and secured with a 3.0 TiCron horizontal mattress sutures.
I thoroughly irrigated all wounds with sterile saline.
Using the C-arm, I pinned the metacarpophalangeal joint in approximately 20 degrees of flexion in antegrade fashion using a 0.045 inch K-wire, which was bent and cut short. Fluoroscopy was used to verify pin position. The MP joint was stable after pinning.
