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Help with op report - What CPT code?

  1. #1
    Default Help with op report - What CPT code?
    Medical Coding Books
    What CPT code?

    In the usual fashion, a bayonet shaped incision was made over the proximal
    first metacarpal, angling volarly and then proximally along the extensor
    brevis and abductor longus tendons. The incision was carried down through
    the dermis. Blunt spreading was used to carry directly down to the joint
    capsule. The gap between the abductor and extensor was used. Any
    neurovascular structures were retracted. The radial artery was identified in
    the proximal end of the wound and was retracted dorsally.

    An incision was made in the dorsal radial aspect of the trapezium metacarpal
    joint. An incision was then carried directly down over the trapezium down to
    the scaphotrapezial joint. Dissection was carried down onto bone and the
    joint capsule was elevated, along with the periosteum off the dorsal radial
    aspect of the joint. The joint capsule was tagged for later reattachment.

    The trapezium was identified and was removed piecemeal. Notably, the distal
    surface was polished, eburnated bone.

    After the completion of the resection of the trapezium, the flexor carpi
    radialis tendon was easily visualized in the depth of the wound.

    Two transverse incisions were made, one proximally, one distally over the
    tendon. The tendon was transected. It was grasped in the depths of the
    wounds and brought out the dorsal radial wound.

    The base of the metacarpal was then resected using the saw, keeping the piece
    very thin. A drill was then used to make a hole in the dorsal radial aspect
    of the thumb metacarpal, connected to a second hole in the base of the
    metacarpal. These were connected using an awl. The tendon was then passed
    through this, and holding the metacarpal in an abducted position with an
    ulnar stress in the base, this was tightened down, and the tendon was sutured
    back on itself, holding some pressure. This was done using two 2-0 grasping
    sutures. The remainder of the tendon was then balled up in an anchovy
    fashion and placed into the space created by the resection of the trapezium.

    The tendon was sutured to the periosteum and the joint capsule of the thumb
    metacarpal, and then the joint capsule was closed over the balled up tendon.

  2. #2
    Modesto, CA; Central Valley Chapter
    Very interesting, I just happened to be reading an OP note that sounds very similar....look at codes 25447 and 25110-59; my surgeon coded this himself and is very good at coding. If nothing else can give you somewhere to start hopefully.


  3. #3
    I agree, its also called a basal thumb arthroplasty, however for the second code, I may lean towards the 25310 for the transfer of the tendon opposed to just the incision of the tendon.

  4. #4
    Modesto, CA; Central Valley Chapter
    Yes, I agree with you. I finished up looking at his report and I agree with to go back and discuss my findings with him.......good thing he's a nice guy!



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