Oklahoma City, OK
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Hel with Orthopedic Surgery Coding Request

1. Right hand crush
2. Extensor pollicis longus tear
3. Extensor digitorum tear to the ring and small fingers
4. Extensor carpi ulnaris tear
5. Comminuted distal ulnar fracture
6. Distal radial ulnar joint disruption and dislocation
7. Perilunate dislocation
8. Acute carpal tunnel syndrome
9. Nondisplaced fracture of the thumb metacarpal

The patient identified in the holding area. The right upper extremity was then prepped and draped in the usual sterile fashion and then the forearm had a large laceration from the mid aspect of the forearm down to the carpal tunnel and a peeling-type of skin degloving for the entirety of the extensor and volar aspect of the hand that measured 10cm. The patient then had irrigation and debridement of the area. There were several loose pieces of bone that were debrided from the wound and then the patient had copious 12 liters of fluid ran through the open injury and numerous pieces of particles were removed. Patient then had the carpal tunnel released as the patient had symptoms preoperatively of numbness and tingling into the tips of fingers and the lunate was dislocated volarly. The carpus was distracted and the lunate was pushed back in through the carpal tunnel and then the carpal tunnel was release and the entirety of the motor branch of the median nerve was visualized and maintained. The patient then had the extensor service visualized and 4-0 vicryl was utilized to epair the EPL, the extensor digitorum to the ring finger and small finger and the extensor carpi ulnaris which were all figure of eight suture repairs. Then the retinaculum was closed over these repairs and then a 10-hole plate was placed onto the ulna, 4 holes were placed proximally into the ulna and then the area of comminution was spanned and then the 4 screws were placed into the distal aspect of the radius. The patient then had the distal radial ulnar joint reduced and 2 K wires were utilized to fix this in routine fashion. Then the patient had copious irrigation of the wound and patient had a complex closure of the 10cm wound with allgower-donati sutures and 4-0 nylon. Patient then had copious irrigation of the wounds. The volar splint was placed over the patient with a thumb spica because there was a nondisplaced metacarpal fracture on the thumb. Patient returned to the recovery room in stable condition.

Please help to code this surgery. Thanks
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