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Thread: 2nd request--please help new coder with CPTs

  1. #1

    Default 2nd request--please help new coder with CPTs

    AAPC: Back to School

    Physician wants 26540 x 2, 26785, 26433, 12034, 11012. Not sure if these are bundled. Thanks for any help.

    I need help with CPTs for the following procedures:

    procedure: irrigation and debridement complex open wound skin flap laceration avulsion crush type injury left ring finger and distal phalanges. Stabilization of open left ring finger DIP joint dislocation. Repair radial ulnar collateral ligaments of the left ring finger DIP joint. Repair extensor mechanism middle to distal phalanx left ring finger in zones one to two. Repair of avulsed skin flap of a total of 12 cm.

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    Is this the entire note? Also the bundleing edits you can check using the CCI website. You can google CCI edits and pull it that way. You should always check the CCI edits and never guess at it.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    here is the actual op note:

    The wound was thoroughly irrigated with antibiotic solution and any small pieces of foreign body material were removed. Patient was noted to have a laceration involving the distal extensor tendon between the distal extensor tendon and the lateral ulnar extensor tendon. The radial ulnar extensor tendon band was partially damaged and a piece was missing from the middle portion of the middle phalanx distally. There was also damage to the triangular ligament. No obvious fractures were noted. After the wounds were thoroughly irrigated with antibiotic solution, clean gloves, clean instruments and clean drapes utilized. Careful exposure of all the damaged structures were performed. Patient was found to have a laceration of the radial and ulnar collateral ligaments to the DIP joint. Extensor tendon injury was noted as above with damage to the radial extensor tendon of the middle phalanx. The skin flap still appeared to have good viability. Attention was first turned to his stabilization of the DIP joint. A 0.45 K-wire ws directed in a retrograde fashion from the DIP joint articular surface out the tip of the index finger and then directed back across the DIP joint. K-wire was placed such that an additional Mitek anchor could be utilized to help with the repair of the extensor mechanism. Once the DIP joint was stabilized a Mitek anchor was placed along the distal portion of the middle phalanx. A micro-Mitek anchor was utilized with a 4-0 fiberwire. The ulnar band of the lateral extensor tendon was repaired to the distal extensor tendon with the 4-0 fiberwire. The sutures were cut and an additional suture was utilized to perform a side-to-side repair of the radial lateral extensor tendon along the remnant of the triangular ligament. The radial and the ulnar collateral ligaments to the DIP joint were also repaired with some of the remaining 4-0 fiberwire. The longitudinal K-wire was cut just below the tip of the skin over the distal phalanx. Image identification confirmed good position of the Mitek anchor as well as a longitudinal K-wire. The distally based skin flap was noted to be viable. Minimal hemostasis was required and minimal trimming of some of the very thin edges of the skin flap was performed. The remaining portion of the bulk of the skin flap was left intact. This was loosely approximated with some interrupted sutures of 4-0 nylon. The skin flap did appear to be viable postoperatively. Xeroform and dry steril dressinges were applied. Patient was placed in well-padded volar fiberglass short-arm splint.

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