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Manipulation with 25295

  1. #1
    Default Manipulation with 25295
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    After informed consent was obtained, an axillary block was administered by anesthesia for intraoperative and postoperative analgesia. The patient was then brought to the operating room, 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, additional sedation was provided, and the patient's hand and forearm were prepped with chlorhexidine and alcohol. An Esmarch bandage was used to exsanguinate the extremity, and an upper arm tourniquet inflated to 250 mm of mercury. Closed manipulation was undertaken, taking careful attention to isolate each joint. Flexion of the metacarpal phalangeal joints was performed first, with palpable release of scar contractures. After this was completed, attention was turned to the proximal interphalangeal joints with metacarpal phalangeal joint flexion. Additional adhesions were felt to release. However, there did remain some stiffness, so decision was made to proceed with extensor tenolysis. An axial 3 cm incision was made over the radiocarpal joint, and tenotomy scissors were used to dissect through the soft tissues. The extensor retinaculum was identified, and the distal aspect was divided, gaining access to the fourth extensor compartment. A Ragnell retractor was used to sequentially isolate and perform traction tenolysis of the extensor tendons at this level. Care was taken to isolate each finger, and some adhesions at the level of the extensor retinaculum were identified. After all procedures have been performed, the fingers were able to be flexed into the palm with minimal difficulty. Tourniquet was then released, with a total tourniquet time of approximately 25 minutes. Hemostasis was obtained using bipolar electrocautery. The wound was irrigated with normal saline, and the incision closed using 4-0 Monocryl in the deep dermal plane, and a running 4-0 Monocryl subcuticular. A dressing was applied, consisting of dry gauze and a gentle Coban wrap. She was awakened from sedation, transferred to the bed, and taken to the postanesthesia care unit in stable condition.

    I am new at this and need to know if the AAOS includes manipulation with the 25295 and it says each tendon and he isolates each finger so I am really confused. Please advise.

  2. #2
    Default surgical release & manipulation
    Manipulating the joint through the range of mation would always be included in a release procedure

  3. #3
    So I would bill 25295 four times with post op pain block correct

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