jvanek82
True Blue
- Messages
- 873
- Location
- Mims, Florida
Good morning!
My surgeon performed this procedure and wants to bill 26145 x 6. We have suggested 25118 as the code but he insists that he did 8 extensor tendons (I only count 5) and wants to bill 26145 x 8 (we use an unlisted code for the extensors since 26145 is flexor tendons) and also an additional code for an I&D of the abscess in the hand, which is unlisted. Does his documentation in this OP note support the wrist coding or hand coding?
The patient was taken back to the OR and underwent anesthesia without complication. The right upper extremity was prepped and draped in the usual sterile fashion. A time-out occurred immediately prior to procedure identifying the correct patient, site, laterality, planned procedure, preoperative antibiotics, availability of equipment and availability of imaging. The arm was exsanguinated the tourniquet was insufflated to 250 mmHg. Fifteen blade was used incise the skin along the dorsal aspect of the right wrist with a extension about the dorsum of the hand in a longitudinal fashion. Subcutaneous dissection performed with tenotomies. Any points of cutaneous bleeding were crossing vessels were cauterized with bipolar cautery. Distally, dissection was carried down to the level of the extensor tendons. There was edematous fluid throughout the wound bed. Culture swab was obtained. More proximally, additional dissection performed with tenotomies to the level of the extensor retinaculum. Inflammatory changes were seen along the dorsum of the extensor retinaculum. This was excised with a rongeur. Next, proceeded with the excisional tenosynovectomy. There was tenosynovitis along the 4th dorsal compartment tendons including the EIP and the 4 EDC tendons. During the course of excisional tenosynovectomy, purulence was able to be decompressed from the 4th, and 2nd compartment. There is additional inflammatory and infectious changes along the 2nd dorsal compartment tendons along the dorsum of the hand and wrist. Additional points of excisional tenosynovectomy was completed of the ECRL and ECRB tendons. Next, dissection performed about the EPL as it crossed over top of the 2nd dorsal compartment tendons. There was infectious changes between the groups of tendons as well as tracking of infectious fluid along the 3rd dorsal compartment. Second culture swab was obtained. After completion of extensor tenosynovectomy of the 2nd, 3rd and 4th dorsal compartment tendons, tendons were further retracted. There was infectious changes throughout the dorsum of the metacarpals and carpus. Excisional debridement was performed of all inflammatory and infectious material. During excision of infectious changes along the dorsum of the capsule, capsule was perforated and additional points of purulence were able to be decompressed from the radiocarpal and midcarpal joint. Arthrotomy was increased in size to allow for additional access. Excisional debridement of synovitis was completed with a rongeur. Having completed debridement of deep abscess, extensor tenosynovectomy, and debridement of septic arthritis, the area was then copiously irrigated. Ten French Hemovac drain was placed through the proximal aspect of the incision and drain was placed within the midcarpal joint. Drain was secured with 4-0 nylon. Tourniquet was let down. Points of cutaneous bleeding were addressed with bipolar cautery. Incision was approximated with 4-0 nylon. Sterile dressing consisting of Xeroform, 4x4s and Webril was applied. Patient was placed in a volar resting plaster splint. Hemovac drain was connected to suction.
Thank you for all your help!
My surgeon performed this procedure and wants to bill 26145 x 6. We have suggested 25118 as the code but he insists that he did 8 extensor tendons (I only count 5) and wants to bill 26145 x 8 (we use an unlisted code for the extensors since 26145 is flexor tendons) and also an additional code for an I&D of the abscess in the hand, which is unlisted. Does his documentation in this OP note support the wrist coding or hand coding?
The patient was taken back to the OR and underwent anesthesia without complication. The right upper extremity was prepped and draped in the usual sterile fashion. A time-out occurred immediately prior to procedure identifying the correct patient, site, laterality, planned procedure, preoperative antibiotics, availability of equipment and availability of imaging. The arm was exsanguinated the tourniquet was insufflated to 250 mmHg. Fifteen blade was used incise the skin along the dorsal aspect of the right wrist with a extension about the dorsum of the hand in a longitudinal fashion. Subcutaneous dissection performed with tenotomies. Any points of cutaneous bleeding were crossing vessels were cauterized with bipolar cautery. Distally, dissection was carried down to the level of the extensor tendons. There was edematous fluid throughout the wound bed. Culture swab was obtained. More proximally, additional dissection performed with tenotomies to the level of the extensor retinaculum. Inflammatory changes were seen along the dorsum of the extensor retinaculum. This was excised with a rongeur. Next, proceeded with the excisional tenosynovectomy. There was tenosynovitis along the 4th dorsal compartment tendons including the EIP and the 4 EDC tendons. During the course of excisional tenosynovectomy, purulence was able to be decompressed from the 4th, and 2nd compartment. There is additional inflammatory and infectious changes along the 2nd dorsal compartment tendons along the dorsum of the hand and wrist. Additional points of excisional tenosynovectomy was completed of the ECRL and ECRB tendons. Next, dissection performed about the EPL as it crossed over top of the 2nd dorsal compartment tendons. There was infectious changes between the groups of tendons as well as tracking of infectious fluid along the 3rd dorsal compartment. Second culture swab was obtained. After completion of extensor tenosynovectomy of the 2nd, 3rd and 4th dorsal compartment tendons, tendons were further retracted. There was infectious changes throughout the dorsum of the metacarpals and carpus. Excisional debridement was performed of all inflammatory and infectious material. During excision of infectious changes along the dorsum of the capsule, capsule was perforated and additional points of purulence were able to be decompressed from the radiocarpal and midcarpal joint. Arthrotomy was increased in size to allow for additional access. Excisional debridement of synovitis was completed with a rongeur. Having completed debridement of deep abscess, extensor tenosynovectomy, and debridement of septic arthritis, the area was then copiously irrigated. Ten French Hemovac drain was placed through the proximal aspect of the incision and drain was placed within the midcarpal joint. Drain was secured with 4-0 nylon. Tourniquet was let down. Points of cutaneous bleeding were addressed with bipolar cautery. Incision was approximated with 4-0 nylon. Sterile dressing consisting of Xeroform, 4x4s and Webril was applied. Patient was placed in a volar resting plaster splint. Hemovac drain was connected to suction.
Thank you for all your help!
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