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Old 09-01-2009, 02:48 PM
ls0403 ls0403 is offline
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Location: Boone, NC
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Default tendon exploration

Patient's finger was hit by soccer ball. Exam/symptoms indicated possible avulsion tendon injury. Patient was taken to OR for tendon repair (flexor profundus, finger). Any ideas what can be coded? Unlisted procedure?

Thanks for your help!

OPERATIVE PROCEDURE: Patient was taken to the operating room and
placed supine on the operating room table. After satisfactory general
anesthesia had been obtained, the left hand and arm was prepped and
draped in the usual sterile fashion. The hand and arm were
exsanguinated with an Esmarch bandage and the tourniquet on the
forearm inflated to 250 mmHg pressure. The volar aspect of the middle
digit was addressed. A Brunner incision was made from the PIP flexion
crease to the pulp of the middle finger. Incision was carried down
through subcutaneous tissue. The tissue was elevated off the
underlying flexor tendon sheath. Exploration revealed that the flexor
profundus insertion on the distal phalanx volar surface was intact and
there was no significant edema, bruising, ecchymosis, etc. in that
area. The A4 pulley was intact and the flexor sublimis and profundus
tendon were present proximal to the A4 pulley. Traction on the
profundus tendon easily flexed the DIP joint. I placed traction on
the tendon and was able to feel the tendon unit pull in the palm and
pull in the volar forearm indicating muscle tendon attachment was
still intact as well. Again traction on the tendon flexed the digit.
With her under anesthesia a tenodesis effect was intact where if I hyperextended the wrist, the PIP joint and DIP joint would flex.
There did not appear to be a disruption of the flexor profundus or
sublimis tendons. The wounds were irrigated, the skin closed with 5-0
nylon. Vaseline gauze and a bulky dressing was applied. The patient
tolerated the procedure well and taken to recovery in stable
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Old 09-02-2009, 04:45 PM
michellelgrd michellelgrd is offline
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so no tendon was repaired? look at 26080 for the exporation
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Old 09-03-2009, 11:01 AM
ls0403 ls0403 is offline
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Thanks for your response! I ended up choosing 26020 + 52 mod (since there was no tendon drainage). Didn't feel comfortable w/ 26080 since it didn't appear that joint was incised.
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