# new coder needs help with CPT and ICD9



## ggparker14 (Dec 27, 2010)

Any help from fellow coders would be appreciated.  Thanks.

procedure: open reduction comminuted left distal radial volar instraarticular fracture with three or more fragments with a locked Synthes 2.4 mm volar plate. Open reduction internal fixation comminuted left distal ulnar metaphysis - neck fracture and ulnar styloid fraction utilizing a Synthes 2.4 mm locking applied locking at T plate.

op note: Curvlinear incision was fashioned over the distal radial volar radius.  Care was taken to protect the radial artery as well as the median nerve. The fascia to the radial side of the flexor carpi radialis was incised. The pronator quadratus was subsequently elevated off the distal radial shaft along the radial border and horizontally along the articular surface taking care to protect the volar ligaments. The fracture fragments were identified. Utilizing a Freer elevator in the fracture site the fracture was reduced. Due to the instability it was temporarily held with a 0.45 K-wire. The Synthes 2.4 mm locked radial volar plate was then temporarily fixed to the distal radius with the K-wires. Once image intensification confirmed good position of the plate, the plate was then transfixed to the shaft with a nonlocking screw. The distal locking screwholes were drilled, measured and appropriate 2.4 mm screws applies. Two remaining screw holes in the shaft were drilled, measured and two additional locking screws were placed. Any temporary K-wires were removed. Permanent x-rays were taken confirming good position of the plate on AP, lateral and oblique views.  

Attention was next turned to the distal ulna. A curvlinear incision was fashioned from the base of the fifth metacarpal along the ulnar aspect of the extensor carpi ulnaris along the shaft of the ulna. Care was taken to protect the dorsal sensory branch of the ulnar nerve. The fascia was elevated between extensor carpi ulnaris and flexor carpi ulnaris. Extensor retinaculum was incised and the fraction exposed. A 2.4 mm stainless steel T plate was then transfixed to the ulnar shaft with the first screw a nonlocking screw. The distal most metaphyseal screw holes were drilled, measured and appropriate screws applied. One screw hole was left open at the level of the fracture site. Fracture fixation appeared to be stable post reduction. Permament x-rays were taken. Tourniquet was released and minimal hemostatis required. 

The wounds were irrigated with antibiotic solution. Pronator quadratus was repaired back over the radial volar plate with interrupted sutures of 2-0 Vicryl. A Blake drain was placed deep in the wound.  Subcutaneous layers closed with a few interrupted sutures of 4-0 Monocryl and skin reapproximated with running subcuticular suture of 4-0 Monocryl. The dorsal ulnar wound was irrigated with antibiotic solution. Extensor retinaculum was repaired with some interrupted sutures of 209 Vicryl. The plate covered with soft tissues. Care was taken to protect the extensor carpi ulnaris and there was no impingement of the extensor carpi ulnaris to a range of motion around the plate. Subcutaneously layers were closed iwth a few interruped sutures of 4-0 Monocryl and skin was reapproximated with a run subcuticular suture of 4-0 Monocryl. Mastisol and Steri-Strips were applied. Patient was placed in well-padded short arm fiberglass splint.


----------

