# Left Thumb MP Joint Volar Plate Tightening



## Joyce Burchett (Nov 9, 2017)

Need help with CPT procedure code.  Left Basilar Joint Arthroplasty--Left Trigger Thumb Release--Left Thumb MP Joint Volar Plate Tightening  Any help would be appreciated.
Op Report:  A 5-cm incision was made over the dorsum of the metacarpal over the first extensor compartment.  Skin flaps were elevated, protecting the cutaneous structures. The joint capsule was then opened sharply. The trapezium was dissected circumferentially, removed piecemeal with a rongeur.  A slip of the APL tendon was then released proximally & maintained distally & brought into wound. This was sutured to the FCR tendon. The rest was placed within the space as well as Gelfoam.  The joint capsule was then closed with a 3-0 Monocryl suture.

Attention was then directed to the volar thumb. A hockey stick incision was made directly over the thumb pulley system. Skin flaps were elevated. The pulley system was then opened completely under direct visualization. The flexor tendon was then retracted. A couple of horizontal mattress sutures were placed in the volar plate to tighten it & prevent hyperextension. The tourniquet was let down. Both wounds irrigated & hemostasis achieved & closed with Monocryl suture. Sterile dressings & a splint was applied. 

Need help with CPT code for this procedure--should use unlisted or would it be appropriate to use 26516 or 26548.  Just not sure what to do with this.


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## daedolos (Nov 9, 2017)

What's your Dx? Facility or professional?

Peace
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## Joyce Burchett (Nov 10, 2017)

This is for the physician billing--Dx: Left basilar joint arthritis & Left thumb volar plate laxity & thumb triggering


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## AlanPechacek (Nov 16, 2017)

You don't say, but I expect you are using 25332 for the Interposition Arthroplasty of the CMC Joint of the Thumb, the first procedure. 

As for the second procedure(s), he did a Trigger Thumb (finger) Release, 26055 (Tendon sheath incision), then/plus the Capsulodesis of the MP Joint of the thumb, for which 26516 is the correct code, even though he called it the Volar Plate.  You may have to check on some of the Edits for these procedures to see if they are bundled or not.  As far as I am concerned, Capsulodesis is not an "element/component" of a Trigger Thumb/finger Release and should be considered a separate procedures.  As such the appropriate Modifiers should be added such as a 59 variant, and/plus 51 for Multiple Procedures.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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