# Please help w/scaphoid excision



## Justarose (Mar 2, 2009)

hands and wrists oh my - are making me sooo unsure - Please help with this one 

A longitudinal incision was made over the dorsal wrist in line with the Lister's tubercle.  Continues flaps were developed.  The EPL was transposed.  The capsule was opened longitudinally.  The scaphoid screw appeared to be penetrated through the dorsal proximal cortex into the scapholunate ligament which was dissociated.  The scaphoid was then removed piecemeal.  He had reasonable cartilage on the proximal lunate involving the lunate facet.  We then denuded the cartilage from the distal lunate proximal capitate, proximal hamate, distal triquetrum.  Once these all bone had been removed, the Lister tubercle was excised and cancellous bone harvested from the wrist.  Once harvested, this was packed into the attempted fusion site.  A 0.062 K-wire was placed holding the lunate in flexion over the capitate and then a 0.045 K-wire was driven in an antegrade fashion, well contained within the capitate, hand drilled with an Acutrak mini drill and then placed the screw across the capitolunate joint.  This appeared to stabilize this quite nicely.  A small stab incision was made over the ulnar aspect of the hand and then a K-wire was placed from the triquetrum grabbing hamate into capitate.  Another 24 screw was then placed, and this compressed this joint nicely.  Before compression, we did place bone graft in all bony surfaces.  The wounds were irrigated.  Radiographs demonstrated good position of the implant.  He had wrist extension of 45 degrees and flexion of 40 degrees.  The wounds were irrigated.  The capsule was closed with 3-0 Ethibond.  The skin was then closed with a 4-0 Prolene.  EPL was left transposed.   The wound was injected with 0.5% Marcaine for postoperative pain control. 

I know this can't be right ..but 25820 ?? 
what about the graft ? 

Dx Codes ? 718.83  ...but not sure of second dx code ...or even if I am any where close ..
Please help 
Thanks


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## BCrandall (Mar 3, 2009)

There's an Arthrodesis for sure, along with a carpectomy with the scaphoid removed. The note mentions an implant, was a scaphoid prosthesis put in? 

I'm thinking 25210-59 and 28525 and/or 25443.

Is there some degenerative arthritis? Prior fracture maybe? Pain from the screw? Why did the doc have to remove the scaphoid?

Arthritis would be 715.34, Screw pain is 996.78 and 729.5.

Hope that helps.

-Bruce


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