Allysaloop
Contributor
Hello there! Would like to see if I can get a second opinion on this, as I want to fully understand this of course! Does this procedure description support 25447 or 25448? I just want to know exactly what I should be looking for that distinguishes the two codes, as "...again suturing it to the APL providing a suspension affect" made me lean more toward 25448. I'm trying to achieve a deeper understanding of rheumatology; these procedures are fascinating! Thank you in advance for your assistance, it means a lot to me.
"Procedure: The patient was given regional anesthetic, and her right arm was prepped and draped sterilely below the tourniquet. The basilar thumb was approached through a 4-cm dorsal radial incision directly over the joint. We dissected down to the interval between the extensor pollicis brevis and extensor pollicis longus. The anatomic snuffbox was identified and opened. An arthrotomy was performed. We protected the radial artery in the snuffbox. We dissected out the trapezium and removed it in piecemeal fashion. There was extensive arthrosis at the trapeziometacarpal joint. The running osteophytes and capsular thickening were removed without difficulty. We then drilled a 4.5-mm bone tunnel from the dorsal aspect of the thumb between the EPL and EPB tendon exiting the palmar medial aspect of the basilar thumb metacarpal. We then incised the FCR tendon approximately 10 cm from its bony insertion and brought the FCR tendon through the trapezial cavity. We tunneled it up through the bony tunnel, exiting it dorsally between the EPL and EPB tendon. We used the surgeon- directed fluoroscope to ensure that we had removed the entire trapezium. We then irrigated the wound thoroughly. The thumb was then distracted and rotated properly. The FCR tendon was then sutured to the dorsal periosteum at the exited point of the bony tunnel. This was done with 3-0 Surgilon. We then used a tendon weaver and passed the FCR tendon around the APL tendon, again suturing it to the APL providing a suspension affect. The FCR tendon was then rolled into an anchovy and then placed into the trapezial cavity. The overlying capsule was reapproximated with 4-0 Vicryl. We then irrigated the wound thoroughly. The skin was closed in layers using 4-0 Vicryl and 5- 0 nylon."
"Procedure: The patient was given regional anesthetic, and her right arm was prepped and draped sterilely below the tourniquet. The basilar thumb was approached through a 4-cm dorsal radial incision directly over the joint. We dissected down to the interval between the extensor pollicis brevis and extensor pollicis longus. The anatomic snuffbox was identified and opened. An arthrotomy was performed. We protected the radial artery in the snuffbox. We dissected out the trapezium and removed it in piecemeal fashion. There was extensive arthrosis at the trapeziometacarpal joint. The running osteophytes and capsular thickening were removed without difficulty. We then drilled a 4.5-mm bone tunnel from the dorsal aspect of the thumb between the EPL and EPB tendon exiting the palmar medial aspect of the basilar thumb metacarpal. We then incised the FCR tendon approximately 10 cm from its bony insertion and brought the FCR tendon through the trapezial cavity. We tunneled it up through the bony tunnel, exiting it dorsally between the EPL and EPB tendon. We used the surgeon- directed fluoroscope to ensure that we had removed the entire trapezium. We then irrigated the wound thoroughly. The thumb was then distracted and rotated properly. The FCR tendon was then sutured to the dorsal periosteum at the exited point of the bony tunnel. This was done with 3-0 Surgilon. We then used a tendon weaver and passed the FCR tendon around the APL tendon, again suturing it to the APL providing a suspension affect. The FCR tendon was then rolled into an anchovy and then placed into the trapezial cavity. The overlying capsule was reapproximated with 4-0 Vicryl. We then irrigated the wound thoroughly. The skin was closed in layers using 4-0 Vicryl and 5- 0 nylon."