# tendon exploration



## ls0403 (Sep 1, 2009)

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!
Lisa

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 
condition.


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## michellelgrd (Sep 2, 2009)

so no tendon was repaired? look at 26080 for the exporation


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## ls0403 (Sep 3, 2009)

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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