# Scaphoid Excision, Radial Styloidectomy, & 4-corner fustion



## KatieGal (Jun 23, 2009)

Hi,  I am hoping that someone can help me with this surgery.  CCI states that I can use a -59 modifier with the scaphoid excision( 25210) but otherwise is bundled into 25800.  Since it is the same incison, would you bill it?
Thanks in advance for any help recieved.   DX help would be appreciated also - only found wrist deformity ( 736.00)

Kate


PREOPERATIVE DIAGNOSIS:  Right SLAC wrist deformity with lunocapitate DJD.

POSTOPERATIVE DIAGNOSIS:  Right SLAC wrist deformity with lunocapitate DJD.

NAME OF PROCEDURE:  Right scaphoid excision, radial styloidectomy(25230) and 4-corner fusion(25800)  


INDICATION: Patient has had a history of problems with his wrist.  He has an obvious old scapholunate ligament injury with a SLAC wrist deformity and also degenerative changes at the lunocapitate joint.  The decision has been made to proceed with a scaphoid excision and 4-corner fusion.  

TECHNICAL PROCEDURE: Patient was brought to the operating room and placed supine on the operating room table.  After adequate anesthesia was administered with general anesthetic, the right upper extremity was prepped and draped in a sterile fashion.  A dorsal approach was made to the wrist.  Dissection continued own through the subcutaneous tissue through the extensor retinaculum which was really just a bunch of scar tissue from a prior procedure.  The dissection continued into the floor of the 4th dorsal compartment where a dorsal capsulotomy was performed.  A subperiosteal/subcapsular dissection was carried out.  The scaphoid was identified and separated from its surrounding tissues and removed.  A radial styloidectomy was done with an osteotome.  Attention was then paid to the 4-corner fusion.  A micro-oscillating saw was used to osteotomize the articular surfaces of the carpal bones involved.  Guide wires for the Acutrak screw set were then placed across the 4 corners of the fusion and appropriate length Acutrak screws were placed.  Good compression was obtained in all fusion sites and fixation was in good position in AP and lateral planes.  The wound was then irrigated.  Subcutaneous tissues were closed with 2-0 chromic.  The skin was closed with 2-0 nylon.  A standard volar and dorsal splint was applied.


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## Bella Cullen (Jun 23, 2009)

I would code 25800 only.


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## KatieGal (Jun 23, 2009)

Thank you for answering - so you would not bill the styloidectomy with code 25800 - is it because it is in the same incision?


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## mitchellde (Jun 23, 2009)

I agree the 25800 only, also dx code I would use the 736.09 for other rather than unspecified and I would code the DJD dx.


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## KatieGal (Jun 23, 2009)

Thank you both for answering - I appreciate the help that this forum gives to us - I read them every day to learn something new.

Thanks again.


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