Good Morning,

Patient injured hand on a pane of glass. DX Right hand palmar glass foreign bodies x4, right small finger ulnar digital nerve laceration, right palm ulnar neuritis, and right palm skin contracture.

Physician, removed 4 pieces of glass, repaired ulnar digigtal nerve laceration, explored & decompressed ulnar nerve through Guyon’s canal and palm and excision right palm skin contracture with Z-plasty.

I am thinking 64831 for nerve repair, 26121 for contracture. The procedure was done through one incision, would the foreign body removal (20525) and Decompression at Guyon’s canal (64719) all bundle? Thanks in advance for your help. This is from the op note:

The right upper extremity was prepped and draped in the usual sterile manner. I began with a Z-plasty around the contracture that was located in the distal palm. The skin contracture was excised and a Z-plasty was made around the skin contracture for later closure. A Bruner type incision was then extended from this area more proximally down the hand. The skin flaps were raised. There was a very large glass fragment present. This was removed in its entirety. This glass fragment had cut the ulnar digital nerve to the small finger. There was a lot of fibrous tissue in this area that clearly had been damaged by this large piece of glass. The large piece was removed. Next were three other small pieces that were present. One of them was present in Guyon's canal located between the ulnar nerve and the ulnar artery. I carefully had to remove this piece of glass as it was in a very tenuous position. It was very sharp and it would cause future problems. The ulnar nerve was explored through this area to fully decompress it and removed the foreign object. There were two other pieces of glass that were present in the palm. These were removed as well using fluoroscopic guidance. The ulnar nerve was fully exposed and noted to be intact other than the small ulnar ulnar digital nerve. The area of the small finger ulnar digital nerve was cleaned of debris and the two ends were brought together and sewed together using an 8-0 nylon suture. Three sutures were applied. The rest of the ulnar nerve was explored.

Gail Steeves, CPC
Coding and Reimbursement Specialist
Carolina Bone & Joint Surgery Center
101 Surgeons Drive
Myrtle Beach, SC 29579