After informed consent was obtained, the patient was brought to the operating room suite and placed on the operating room table in supine position. A pause was undertaken to confirm the patient, as well as location of surgery. Once this was confirmed, general anesthesia was induced, and the patient's hand and forearm were prepped with chlorhexidine and alcohol, and draped in a normal sterile fashion. An Esmarch bandage was used to exsanguinate the extremity, and an upper arm tourniquet was inflated to 250 mm/Hg. The finger traps were applied, and ten pounds of axial traction was applied as well. Once this was applied, Lister's tubercle was marked, as well as the extensor carpi ulnaris tendon.

An incision was made in the 3-R port. An incision was made and a blunt clamp was used to dissect down to the level of the radiocarpal joint. Prior to entering into the joint, 10 cc of 1% plain lidocaine was injected into the joint, both for distention and identification. The joint was entered bluntly, and then a blunt trocar was inserted, and then the scope. Confirmation was made to be in the radiocarpal joint. The radioscaphoid articulation appeared to be normal. The scapholunate ligament was found to be intact. The lunate and lunate fossa of the radius showed evidence of arthritis. Progressing to the ulnar side of the wrist, visualization became very difficult because there was a large amount of what appeared to be old inflammation. There was a small amount of recent inflammation, which appeared as hyperemic scar tissue within the ulnocarpal region. This, combined with a large amount of what appeared to be chronic devascularized inflammatory tissue, was observed. Attempts were made to gain visualization in an attempt to insert an arthroscopic shaver, however, the amount of inflammation was quite significant, and after multiple attempts decision was made to proceed with a mini open approach, and then incision was made along the ulnar border of the extensor carpi ulnaris tendon. The tendon was unroofed from its sheath, after protection of the dorsal ulnar cutaneous nerve. The ulnar sheath was opened, and there appeared to be a fair amount of chronic inflammation of the extensor carpi ulnaris tendon. There was a thick rind around the tendon itself. The extensor carpi ulnaris tendon was retracted radially, and the ulnocarpal joint was entered in the sub-sheath of the extensor carpi ulnaris tendon. The ulnocarpal joint was visualized, and the inflammatory tissue was able to be visualized within the joint itself. A synovectomy rongeur was used to gently débride this region. The triangular fibrocartilage complex, at its peripheral aspect, was observed and found to be intact.

Ok I know that we need to code this as open. But I am at a loss. Could someone point me in the right direction?