# 25310?



## codedog (Mar 22, 2011)

would cpt codes 26055, 25447, and 25310  fit this operative report?



POSTOPERATIVE DIAGNOSES:  Right long trigger finger and left CMC arthrosis.
ANESTHESIA:  General.
PROCEDURES PERFORMED:  Right long trigger finger release and left wrist CMC arthroplasty with trapeziectomy and use of flexor carpi radialis tendon graft.
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PROCEDURE IN DETAIL:
 Patient had failed conservative modalities.  Patient  had left radial wrist pain from CMC arthritis and right long trigger finger.  presented to the operating suite for both.  Both sides were marked and confirmed with the patient.  Preoperative antibiotics were given.  was brought to the operating room.  Anesthesia was instituted without difficulty.   trigger finger was addressed first.  Tourniquet was applied to upper extremity.  Right lower extremity prepped and draped in a normal sterile fashion.  Tourniquet was applied at 250 mmHg and longitudinal incision was made to distal palmar crease.  Careful dissection revealed the first annular pulley which was released with a end-cutting Beaver blade.  Care was taken not to damage the underlying tendons, and the flexor tendons moved freely after the release.  The wound was irrigated, closed with a 4-0 nylon suture, and soft dressings applied.  The tourniquet was deflated and disconnected.  The left side was addressed next, prepped and draped in a normal sterile fashion.  Tourniquet inflated to 250 mmHg in standard fashion.  Curvilinear incision was made over the left trapezium and base of the left thumb metacarpal.  Trapezium was identified and confirmed with fluoroscopic imaging.  Trapeziectomy performed with an osteotome and rongeur.  Care was taken not to damage the underlying tendon.  The trapezium is removed in its entirety.  It had loose bodies noted as well in the joint that were removed.  The base of the metacarpal was drilled with a 2.0-mm drill bit to facilitate reconstruction of the ligament.  A separate incision was made over the flexor carpi radialis tendon that was incised in its mid portion.  Half the tendon was released proximally, brought out through the wrist into the defect of the trapeziectomy, passed through the drill hole of the metacarpal using a Houston suture passer and sewn on to itself with ligamentous reconstruction.  The tendon itself was rolled anteriorly and sutured with a 2 0 Vicryl suture and sutured down to the existing flexor carpi radialis tendon base and packed into the defect after the wound was irrigated.  Closure of the fascial tissue and capsule was performed followed by 2-0 Vicryl sutures and 4-0 nylon sutures superficially.  She was placed on a thumb spica splint.  She tolerated the procedure well.  All sponge and needle counts were correct.  There were no complications.


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## codedog (Mar 23, 2011)

i think i'am on the right track


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## ozarkortho (Mar 24, 2011)

Trent,
This is the same way that I would code this.  Our hand surgeon does the same thing and I would code the same way.


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