# Manipulation under anesthesia, HELP!



## joanne71178 (Mar 29, 2013)

I would like to get a second opinion on this dictation.   I am having a difficult time deciphering exactly what procedures were performed.  

Post OP Diagnosis: Mangled right upper extremity, status post repair with arthofibrosis of the forearm, wrist and digits.

Operation Performed: Manipulation under anesthesia of the elbow, wrist, fingers and thumb, right arm.  

Indications:  This is a 28 yo male whose arm was caught and ripped apart on a conveyer belt.  This was reconstructed with repair and extensor tendon grafting with skin grafts.  He has gone on to for the most part heal however, he has severe limitation to range of motion to the point where he can barely move his fingers in flexion or in extension.  He is indicated for manipulation under anesthesia. 

Findings and Procedure: His right upper extremity was identified during the surgical pause and then manipulated.   Initially he had very limited finer and thumb motion. With forcible flexion of the digits, releases could be felt in the IP an MCP joints.  He  was then manipulated forward flexion and extension at the wrist, again with palpable and audible releases throughout. 

The supination proved more challenging.  His arm had only a few degrees of supination passively on initial testing and, with forcibly manipulation consisting of tight grasping and pressure on the radial shaft to avoid excessive torsion on the incomplete union of the fracture it was possible to finally achieve about 70 degrees of supination with significant pressure.  On release,  the arm would return to about 45 degrees of supination.  There was some shearing of the superficial layer of the skin graft but there appeared to be healthy tissue beneath.  A couple of sutures were identified and these were removed where they had not yet absorbed.   


The 1st Paragraph I would code 26340 RT, 26340 59, RT for the IP and MCP joints.  
25259 RT for the wrist 

To me the  2nd paragraph is very confusing;  Is he manipulating the Elbow (24300, 718.52)or the mal-union fracture of the radial shaft(25500,733.81,813.21)??  

Also V15.51 and Injury code E918

Any help deciphering is much appreciated!


----------



## nyyankees (Mar 29, 2013)

joanne71178 said:


> I would like to get a second opinion on this dictation.   I am having a difficult time deciphering exactly what procedures were performed.
> 
> Post OP Diagnosis: Mangled right upper extremity, status post repair with arthofibrosis of the forearm, wrist and digits.
> 
> ...



Before you submit any codes I would check to see if the carrier will cover MUA. Most only cover knee and back only.


----------



## joanne71178 (Apr 3, 2013)

Any other thoughts on how to code?  I'm having a difficult time with this one. 
The insurance is CA WC

Thanks


----------

