# finger tendon transfer help needed please



## tvbrew21 (Dec 6, 2017)

Can anyone help me with coding this? 
PERATIVE REPORT

PREOPERATIVE DIAGNOSIS:  Extensor tendon rupture right index and middle finger.

POSTOPERATIVE DIAGNOSIS:  Extensor tendon rupture right index and middle finger.

PROCEDURES:
1.  Flexor digitorum superficialis tendon transfer from right middle finger to
    extensor digitorum communis to the right index and middle fingers.
2.  Right short-arm plaster splint application.

INDICATIONS:  Patient has been followed for chronic extensor tendon rupture to
her right index, middle, and ring fingers.  She had previously underwent
extensor tendon transfer for right index, middle, and ring fingers.  She has had
multiple falls following her initial surgery and had ongoing significant
extensor tendon lag about her right index and middle finger.  She had failed
conservative management.  She was explained the risks, benefits, and
alternatives of procedure and consent was obtained.  She had no further
questions.

OPERATION:  The patient was seen and examined and her right index and middle
fingers were preoperatively marked.  The patient was given intravenous
antibiotics preoperatively.  The patient was transferred to the operating room
in the supine position.  Time-out was performed.   All members present were in
agreement.  Patient was given adequate sedation and anesthesia service performed
a right brachial plexus block without difficulty.  The local anesthetic was
infiltrated along the volar forearm, dorsal wrist and a digital block of the
right middle finger.  Tourniquet applied to the right upper arm and the arm was
placed on the arm table.  The right upper extremity was prepped and draped in
usual sterile fashion.  Esmarch used to exsanguinate the right upper extremity.
Tourniquet was applied to 200 millimeters of mercury.  A #15 scalpel blade was
used to make a transverse incision along the mid dorsal wrist through the prior
scar.  Blunt dissection was performed down to the extensor retinaculum.  There
was moderate adhesions which were released.  Next a transverse incision was made
just distally over the prior extensor tendon transfer.  There was significant
local synovitis around the extensor tendon transfer about the index, middle, and
ring finger extensor digitorum communicates tendons.  The repair was intact.
There was mild laxity of the extensor tendon to the index and middle finger
distally.  These adhesions were released.  The extensor tendons to the index and
middle fingers were transected just distal to the prior repair.  At this stage,
the hand was turned over and a curvilinear incision made along the volar aspect
of the proximal interphalangeal joint of the middle finger.  The flexor
digitorum superficialis tendon was transected at the distal insertion site and
was retrieved with a volar forearm transverse incision without difficulty.  At
this stage, the interosseous membrane was identified and blunt puncture wound
was performed with a hemostat.  The tendon passer was used to pass the harvested
tendon through the interosseous membrane and was brought out dorsally through
the dorsal wrist incision.  This was then fed distally through the extensor
retinaculum and a side-to-side extensor tendon transfer to the index and middle
finger extensor digitorum communis tendons was performed with 3-0 Ethibond
suture.  There was appropriate tension noted with full passive flexion of the
digits and with the wrist flexed the index, middle, and ring fingers extended
passively.  The wounds were irrigated with saline.  The redundant flexor
digitorum superficialis tendon was transected distally and discarded.  The
wounds were repaired using 4-0 Monocryl interrupted suture and the skin edges
reapproximated using 4-0 nylon horizontal mattress suture.  Tourniquet was taken
down.  Hemostasis was observed.  Xeroform soft bulky dressing and dorsal volar
short-arm extension splint with overlying Ace wrap was applied.  The patient's
arm was placed in a sling.  The patient tolerated the procedures well.  The
sponge and instrument counts were correct.  The patient was awake, stable, and
transferred to recovery room in satisfactory condition.


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## MI_CODER (Dec 6, 2017)

I came up with 25310 x2 and S56.411A and S56.413A.

I wouldn't code for the splint application because (to me) he's using the splint just as some sort of stabilization and protection for after the surgery.


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## tvbrew21 (Dec 7, 2017)

*Thank you!*



OrthoCoder104 said:


> I came up with 25310 x2 and S56.411A and S56.413A.
> 
> I wouldn't code for the splint application because (to me) he's using the splint just as some sort of stabilization and protection for after the surgery.



Thank you for your help!!!!


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## MI_CODER (Dec 9, 2017)

You're welcome. I'm glad I could help.


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