# help for new coder with cpt



## ggparker14 (Dec 13, 2010)

I need opinions on the following procedure.  I am looking at 26540 for the ulnar collateral ligament repair, but unsure about the other repairs. Any help is appreciated.  Thanks.

Procedure:  irrigation and debridement right ring finger wound involving the skin and subcutaneous tissue, muscle and bone. Repair of ulnar collateral ligament right ring finger at the metacarpal phalangeal joint with the Mini Mitek suture anchor in 2.0 braided nonabsorbable suture. Repair of the joint capsule and joint synovium right ring finger, metacarpal phalangeal joint. Repair partial tear along the oblique fibers ulnar aspect of the extensor mechanism right ring finger at the metacarpal phalangeal joint level. Loose delayed primary skin closure of stellate wound right dorsum of the right hand over the ring finger and loose delayed primary closure 1 cm laceration over the first dorsal web space. 

Op note:  The wounds were thoroughly irrigated with antibiotic solution including the skin, subcutaneous tissue and metacarpal phalangeal joint. The total length of the wounds between the two wounds measured approximately 6 cm.
After the wounds were thoroughly irrigated, clean gloves, clean drapes and clean instruments utilized. Utilizing image intensification Mini Mitek suture anchor was placed in the ulnar aspect of the proximal phalanx of the ring finger. Image intensification confirmed good position of the suture anchor. The ulnar collateral ligament was thenr repaired at its attachment level. Tension was checked and was noted to be in good position. Utilizing a 4-0 Monocryl the tenosynovium was repaired over the joint capsule as well as the joint capsule to the metacarpal phalangeal joint ulnar aspect. The extensor tendon itself was intact as well as the ulnar lateral band but there was laceration along some of the ulnar oblique fibers of the extensor mechanism. This was repaired with some interrupted mattress sutures of 4-0 Tycron. Tourniquet was released, minimal hemostasis required. This skin was loosely reapproximated with interrupted sutures of 4-0 nylon over the ring finger as well as over the small laceration over the first dorsal web space. Some Betadine dressings that were just slightly moistened with Betadine were placed over the wounds. Cast padding and 4x4s were placed between the fingers incorporated.


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