cynthiag14
Contributor
For patient's with Charcot Marie Tooth Disease with previous oppensplasty and mcp joint fusions. If the provider is performing a Zancolli volar plate advancement of the MCP joint with supplemental Mitek anchor of the index-small fingers. Would this be best represented as CPT 26518-Capsulodesis, MCP joint; 3 or 4 digits? I was also looking at 26499-Correction claw finger, other methods. It is a very lengthy operative note and I will post one portion of the procedure. Thank you.
"Starting with the index finger, we identified the neurovascular bundles. We identified the A1 pulley and released it. We released the palmar pulley. We then reflected the tendons radially and were able to expose the neck of the metacarpal. We now cleared the landing spot for the volar plate advancement. We then elevated the volar plate proximally to the level of the articular surface. By pulling on the volar plate, we now could advance the MP joint, placing it in flexion. With the index finger now prepared, we now prepared the long finger. Again, this was done in the same manner, releasing the A1 pulley, releasing the palmar pulley, retracting the flexor tendons, elevating the volar plate off the metacarpal head fully. Again, secondary check, the pulling arm, the release volar plate would bring the metacarpophalangeal joint into flexion."
"Starting with the index finger, we identified the neurovascular bundles. We identified the A1 pulley and released it. We released the palmar pulley. We then reflected the tendons radially and were able to expose the neck of the metacarpal. We now cleared the landing spot for the volar plate advancement. We then elevated the volar plate proximally to the level of the articular surface. By pulling on the volar plate, we now could advance the MP joint, placing it in flexion. With the index finger now prepared, we now prepared the long finger. Again, this was done in the same manner, releasing the A1 pulley, releasing the palmar pulley, retracting the flexor tendons, elevating the volar plate off the metacarpal head fully. Again, secondary check, the pulling arm, the release volar plate would bring the metacarpophalangeal joint into flexion."