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Resection of metacarpal heads and arthroplasties

  1. #1
    Default Resection of metacarpal heads and arthroplasties
    Medical Coding Books
    I need help on this report please! So far I am not sure about the metacarpal head resection - the closest I could come is 26230 x4???
    Then for the arthroplasties, maybe 26531 x4???
    For Dupuytren's a 26123? or is some of it included in some?

    NAME OF OPERATION: 1. Open palm release of Dupuytren's.
    2. Resection of metacarpal heads and flexible implant arthroplasties, index through small fingers.

    INDICATIONS: This gentleman has history of Dupuytren's and rheumatoid arthritis and is here for the above-listed procedures.

    PROCEDURE: The patient was taken to the operating room. After adequate general anesthesia was obtained, the left arm was prepped with Betadine scrub and solution and draped in the usual sterile fashion. A transverse incision was made in the palm and the pretendinous cords were released. The digital nerves were located and protected. The fingers were manipulated into extension.

    Two longitudinal incisions were made, one in between the index and middle fingers and the second in between the ring and small fingers. Dissection was carried down through the subcutaneous tissues to the extensor tendons. All were subluxed in the ulnar gutters. All ulnar intrinsics were released including the abductor digiti quinti to the small finger. The metacarpal heads were resected with the oscillating saw and the bases of the proximal phalanges flattened as well. The canals were prepared sequentially with reamers and broaches.
    The index, middle, ring, and small finger sizes selected were 20, 30, 20, and 10 with the small finger having a reversed implant. Holes were made in the dorsoradial corners of the metacarpal necks and 2-0 suture placed for ligament reattachment. The finger could be placed to about 30 degrees short of full extension without rebound. The extensor tendons were centralized over the metacarpal heads radially by imbricating the lax sagittal band tissue. The skin was then closed with interrupted 5-0 nylon on the dorsal aspect of the hand. The palmar wound was left open.

  2. #2
    for the open palm dupuytren's release it is definetly 26040 as it was of the palm only and i do not see that a graft was done, if a graft was done then use 26121. As for the resection of the metacarpal that code is 26250 x4
    the arthroplasty w/ implant im not sure of as the joint was not specified.
    hope this helps good luck
    Last edited by michellelgrd; 09-01-2009 at 08:52 AM.

  3. #3
    Thanks for your reply Michelle!

    I was confused with the releases of the fingers, but I have decided to go with 26045 (instead of 26123), since it was an open procedure (26040 is percutaneous).

    I don't think the 26250 is correct, because it was only the metatarsal HEADs, and not a radical resection (for a tumor). I think I am going to use 26531 for the arthroplasties, and I researched a little bit more and found out that it includes "bony resection and preparation of bone for implant insertion", according to CodeX's GSD.

    Thanks again!

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