CHASITYWATSON
New
I was hoping someone could help me determine if they think 26715 and 26520 are appropriate for the operative note below. The code that was sent when the surgery was booked was 26437 but I'm don't agree. I appreciate any help with this.
POSTOPERATIVE DIAGNOSIS: Left long finger incarcerated radial collateral ligament with rotary subluxation of metacarpophalangeal joint.
OPERATIONS PERFORMED: Release of left long finger radial collateral ligament and open reduction of left long finger metacarpophalangeal joint.
DESCRIPTION OF PROCEDURE: The patient was met in the holding area. The surgical site was marked and confirmed. Questions were answered. We then proceeded to the OR. Once in the OR, the patient underwent administration of IV sedation. The bed was rotated to allow better access to the left upper extremity. Forearm tourniquet was applied. The patient then underwent infiltration of local anesthetic into the soft tissues overlying the dorsum of the left long finger MCP joint. After adequate local anesthesia had been obtained, I made a straight longitudinal incision centered over the MCP joint. Sharp dissection through the skin was carried down to the extensor mechanism. I visualized the extensor mechanism and noted no injury to the sagittal band, and the extensor mechanism was centrally placed. At this juncture, I summarized that the patient most likely had incarceration of the collateral ligament causing rotary subluxation of the joint. I attempted to insufflate the joint with local anesthetic in an attempt to free up the collateral ligament. I insufflated the MCP joint and then attempted gentle reduction with rotation of the MCP joint by rotating the proximal phalanx and gently placing an extension force on it. There was no release of the collateral ligament, and the joint remained stuck. I made incisions on either side of the extensor tendon and opened the capsule. I entered the capsule with the blunt end of a Freer elevator and entered the joint in an attempt to release the collateral ligament and allowed for extension of the digit.
I was unable to release the collateral ligament. I then after several attempts realized that I was making no progress and decided to make an incision on the volar aspect of the long finger MCP joint.I injected 10 mL of local anesthetic and made a longitudinal incision from the distal palmar crease down to the MCP flexion crease. Sharp dissection through the skin was followed by blunt dissection. I exposed the tendon sheath and opened the A1 pulley and retracted the flexor tendons radially. I then incised the volar plate of the MCP joint and released a portion of the ulnar collateral ligament with inability to fully straighten the digit. I then retracted the flexor tendons ulnarly and released the remainder of the volar plate and a portion of the radial collateral ligament. I was then able to extend the joint with a satisfying clunk, and the joint reduced. It was then freely mobile to passive range of motion, full flexion, and extension. No instability of the joint.The tourniquet was deflated. The wounds were thoroughly irrigated. I obtained hemostasis with pressure and elevation. I closed the incision using a 5-0 nylon. I washed and dried the extremity and applied dressings of Xeroform, sterile 4x4s, sterile Webril, and a volar splint of plaster out to the PIP flexion crease with the MCP joint extended. This was overwrapped with an Ace bandage. All digits were pink and viable on conclusion. The patient was then awakened and taken to the recovery room. He arrived in the recovery room in stable condition still under the influence of IV sedation. All counts were correct x2.POSTOPERATIVE CARE OF CARE: I will have him followup in 2 weeks for splint removal and suture removal, try and have the therapist see him at about 10 days for splint fabrication and to begin range of motion exercises.
POSTOPERATIVE DIAGNOSIS: Left long finger incarcerated radial collateral ligament with rotary subluxation of metacarpophalangeal joint.
OPERATIONS PERFORMED: Release of left long finger radial collateral ligament and open reduction of left long finger metacarpophalangeal joint.
DESCRIPTION OF PROCEDURE: The patient was met in the holding area. The surgical site was marked and confirmed. Questions were answered. We then proceeded to the OR. Once in the OR, the patient underwent administration of IV sedation. The bed was rotated to allow better access to the left upper extremity. Forearm tourniquet was applied. The patient then underwent infiltration of local anesthetic into the soft tissues overlying the dorsum of the left long finger MCP joint. After adequate local anesthesia had been obtained, I made a straight longitudinal incision centered over the MCP joint. Sharp dissection through the skin was carried down to the extensor mechanism. I visualized the extensor mechanism and noted no injury to the sagittal band, and the extensor mechanism was centrally placed. At this juncture, I summarized that the patient most likely had incarceration of the collateral ligament causing rotary subluxation of the joint. I attempted to insufflate the joint with local anesthetic in an attempt to free up the collateral ligament. I insufflated the MCP joint and then attempted gentle reduction with rotation of the MCP joint by rotating the proximal phalanx and gently placing an extension force on it. There was no release of the collateral ligament, and the joint remained stuck. I made incisions on either side of the extensor tendon and opened the capsule. I entered the capsule with the blunt end of a Freer elevator and entered the joint in an attempt to release the collateral ligament and allowed for extension of the digit.
I was unable to release the collateral ligament. I then after several attempts realized that I was making no progress and decided to make an incision on the volar aspect of the long finger MCP joint.I injected 10 mL of local anesthetic and made a longitudinal incision from the distal palmar crease down to the MCP flexion crease. Sharp dissection through the skin was followed by blunt dissection. I exposed the tendon sheath and opened the A1 pulley and retracted the flexor tendons radially. I then incised the volar plate of the MCP joint and released a portion of the ulnar collateral ligament with inability to fully straighten the digit. I then retracted the flexor tendons ulnarly and released the remainder of the volar plate and a portion of the radial collateral ligament. I was then able to extend the joint with a satisfying clunk, and the joint reduced. It was then freely mobile to passive range of motion, full flexion, and extension. No instability of the joint.The tourniquet was deflated. The wounds were thoroughly irrigated. I obtained hemostasis with pressure and elevation. I closed the incision using a 5-0 nylon. I washed and dried the extremity and applied dressings of Xeroform, sterile 4x4s, sterile Webril, and a volar splint of plaster out to the PIP flexion crease with the MCP joint extended. This was overwrapped with an Ace bandage. All digits were pink and viable on conclusion. The patient was then awakened and taken to the recovery room. He arrived in the recovery room in stable condition still under the influence of IV sedation. All counts were correct x2.POSTOPERATIVE CARE OF CARE: I will have him followup in 2 weeks for splint removal and suture removal, try and have the therapist see him at about 10 days for splint fabrication and to begin range of motion exercises.