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Thread: Closed txt fx with external fixator and CTL

  1. #1
    Join Date
    Apr 2007

    Default Closed txt fx with external fixator and CTL

    AAPC: Back to School
    Hello, I could use some advice on this report. Also, I have not been able to find a code for the external fixator itself. Is this separately codable? Is there a code for it? They used a Synthes External Fixator per the implant log.

    DX: Right wrist fracture dislocation of carpus and acute carpal tunnel syndrome

    Name of Procedure: Right Wrist external fixator application:
    Carpal Tunnel Release
    Radial Carpal Pinning
    The Right arm was exsanguinated and tourniquet was elevated to 250mmHG. With image intensifier in place, a closed reduction was performed on the carpus and it was noted to reduce into a relatively appropriate position. At this time, the patient was placed in a palm up position and carpal tunnel release was performed making a skin incision in the distal wrist crease curving distalwards slightly towards the thenar eminence. The subcutaneous tissues were divided sharply. The transverse carpal ligament was identified and incised with a 15 blade scalpel. A hemostat was placed underneath to protect the subjacent structures and released in the distal and proximal directions. The ends of the release were completed with the tenotomy scissors. The medican nerve was identified. There was noted to be no rent in the volar ligament of structures that was visualized and prlpated in the carpal tunnel. The wound was irrigated copiously and the skin closed with 4.0 Nylon horizontal mattress sutures. Next, the external fixator ws applied to the right wrist with two pins in the mid distal radius and two pins in the index finger metacarpal. The wrist was held in a closed reduced position and the connector rod was placed between the two double pin sets, and slight traction and flexion were applied. The rod was tightened to the external fixator pins in an appropriate fashion. The contruct was imaged in the AP and lateral planes. There was noted to be minimal residual subluxation. For this reason, it was determined to place a radial carpal pin as well, and this was placed proximal to the radial styloid, obliquely through the radius. The wrist was held manually in a closed reducted position with the lunate seated well into the lunate fossa of the radius. The pin wwas driven across into the carpus. This was imaged with the APand latera planes and position was noted to be appropriate. The pin was bent and cut. Again image intensifier was used in the AP and Lateral planes and position and reduction was noted to be nearly anatomic.

    The surgeon stated to code 25515,25675,64721. I do not agree.

    My thoughts are: 20692, 64721-RT,25635-RT with DX: 833.03, 814.00, 354.0

    Anyone care to give an opinion on this for me? The external fixator was almost $1000.00, and this is an ASC setting.

    Thank You in Advance.

  2. #2
    Join Date
    Apr 2007


    for the ex fix you will use L8699

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