I am at a loss...can anybody help??
Dictation:
The wound extended across the wrist crease onto the palm in Brunner fashion. The ulnar limb of the laceration was extended proximally. Full-thickness skin flaps were elavated. Dissection was carried through the subcutaneous tissues. The FCU tendon was noted to be cut 65% of its substance on the ulnar side of the wrist. We retracted the tendon and explored the ulnar neurovascular bundle. There was NO INJURY. Speciacally, the ulnar nerve was released from the distal forearm through Guyon's canal. The ulnar nerve was then decompressed deep to the fascial edge of the hypothenar fascia. No Injury Noted. We then tunneled radially and divided the transverse carpal ligament from the V between the hypothenar and thenar fascia to just radial to the hook of the hamate. We identified all of the flexor tendons within the carpal tunnel and more proximally in the forearm. There was no injury to the underlying tendons. Speciacally, the FDS and FDP to the ring and small fingers were not injured. Tenosynovectomy was performed in order to confirm this. There was NO INJURY to the underlying median nerve, either. The wound was then washed out with 500 mL of normal saline. Grinder debris was removed. The flexor carpi ulnaris tendon substance was repaired with 3-0 Ethibond modified Kessler suture. AmnioFix was placed around the tendon repair site.
Physician wants to bill:
64719
64721
25116
25260
25115
26145
On my own, I personally came up with: 25260, 64721-59
Any suggestions???
Dictation:
The wound extended across the wrist crease onto the palm in Brunner fashion. The ulnar limb of the laceration was extended proximally. Full-thickness skin flaps were elavated. Dissection was carried through the subcutaneous tissues. The FCU tendon was noted to be cut 65% of its substance on the ulnar side of the wrist. We retracted the tendon and explored the ulnar neurovascular bundle. There was NO INJURY. Speciacally, the ulnar nerve was released from the distal forearm through Guyon's canal. The ulnar nerve was then decompressed deep to the fascial edge of the hypothenar fascia. No Injury Noted. We then tunneled radially and divided the transverse carpal ligament from the V between the hypothenar and thenar fascia to just radial to the hook of the hamate. We identified all of the flexor tendons within the carpal tunnel and more proximally in the forearm. There was no injury to the underlying tendons. Speciacally, the FDS and FDP to the ring and small fingers were not injured. Tenosynovectomy was performed in order to confirm this. There was NO INJURY to the underlying median nerve, either. The wound was then washed out with 500 mL of normal saline. Grinder debris was removed. The flexor carpi ulnaris tendon substance was repaired with 3-0 Ethibond modified Kessler suture. AmnioFix was placed around the tendon repair site.
Physician wants to bill:
64719
64721
25116
25260
25115
26145
On my own, I personally came up with: 25260, 64721-59
Any suggestions???