Volar Scar Contracture - How would you code this?

plasticscoder

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Can't determine if we should go with 14040/15050/[20650?-insertion of pin] OR refer to hand codes? Please help, thanks.


PREOPERATIVE DIAGNOSIS: Severe scar contracture of distal interphalangeal and proximal interphalangeal joints, left ring finger.

POSTOPERATIVE DIAGNOSIS: Severe scar contracture of distal interphalangeal and proximal interphalangeal joints, left ring finger.


OPERATION:
1. Excision and release of volar scar tissue, left ring finger, 1 cm x 3 cm.
2. Volar rearrangement of tissue.
3. Full-thickness skin graft x2, each 1 x 1.5 cm, volar left ring finger.
4. Release of contractures and K-wire fixation of proximal interphalangeal and distal interphalangeal joints. 5. Bulky dressing.


FINDINGS/TECHNIQUE: The patient was placed in the supine position, where he was sterilely prepped and draped. A tourniquet was inflated to 200 mmHg after exsanguination by direct pressure. A zigzag incision was made on the volar aspect over the scar tissue. Scar tissue was carefully dissected. Discarded flaps were thinned to appropriate thickness and then transposed to cover the middle phalanx volar tissue, leaving open wound of the DIP and volar PIP joints. This skin was then harvested transversely at the ulnar wrist crease and longitudinally over the ulnar hypothenar region. Both these areas were harvested with a 15-blade scalpel, defatting the full-thickness graft in place. Closure of the donor sites was done with deep interrupted 5-0 Monocryl sutures and 5-0 chromic for skin approximation. Skin grafts were then sutured into place with 5-0 chromic catgut. The tourniquet was deflated. A pressure dressing was applied. Then Xeroform was applied to the finger. Hyper-extension of the DIP joint was done with a single 28-gauge wire longitudinally, and another wire was passed for the PIP joint in full extension. A bulky dressing was applied, including an Ace wrap. The patient tolerated the procedure well and was transferred to the recovery room in satisfactory condition.
 
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