coderguy1939
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Pre and Post op DX is Nonunion right thumb metacarpal fracture articular fragments and osteophyte.
Procedures
Revision of multiple fragments at the base of the first metacarpal
Excsion of fracture fragments at the base of the first metacarpal
Here is the Procedure in Detail:
Under flourscopic guidance , an incision was made directly over the area that provided greatest exposure to the fragments. This was done slightly ulnar to the base of the fifth metacarpal. This was done afer radial nerve block had been performed at the superficial radial nerve. Also the procedure was carried out after Esmarch exsanguination and tourniquet inflation. With full-thickness flaps elevated, great care was taken to protect the dorsal structures including neurovascular structures and tendons. The base of the first metacarpal ws carefully exposed. There were multiple fragments noted inside of the joint. These were carefully excised in their entirety. Copious irrigation was undertaken to wash off the entire joint. Adjacent to the metacarpal sitting slightly ulnar and volar was a fragment of bone whcih was not united. The actural origination of this bone fragment ws noted to be extraarticular. This fragment was then excised. C-arm intensifier was then broght to confirm alignment and stabililty of the metacarpal joint. Following this, copious irrigation was undertaken. The wound was carefully closed in layers etc. The doctor wants to use the following codes:
26615
25130
I'd appreciate some opinions on how this should be coded.
Procedures
Revision of multiple fragments at the base of the first metacarpal
Excsion of fracture fragments at the base of the first metacarpal
Here is the Procedure in Detail:
Under flourscopic guidance , an incision was made directly over the area that provided greatest exposure to the fragments. This was done slightly ulnar to the base of the fifth metacarpal. This was done afer radial nerve block had been performed at the superficial radial nerve. Also the procedure was carried out after Esmarch exsanguination and tourniquet inflation. With full-thickness flaps elevated, great care was taken to protect the dorsal structures including neurovascular structures and tendons. The base of the first metacarpal ws carefully exposed. There were multiple fragments noted inside of the joint. These were carefully excised in their entirety. Copious irrigation was undertaken to wash off the entire joint. Adjacent to the metacarpal sitting slightly ulnar and volar was a fragment of bone whcih was not united. The actural origination of this bone fragment ws noted to be extraarticular. This fragment was then excised. C-arm intensifier was then broght to confirm alignment and stabililty of the metacarpal joint. Following this, copious irrigation was undertaken. The wound was carefully closed in layers etc. The doctor wants to use the following codes:
26615
25130
I'd appreciate some opinions on how this should be coded.