# Excision of neuroma Reconstruction of radial digital nerve and autograft



## MELJNBBRB (Jun 10, 2015)

64782? Newbie here, need help please


MJNB,CCS,CPC




DIAGNOSIS:

1. Left long finger neuroma.




POSTOP DIAGNOSIS:

Same.




PROCEDURE:

1. Excision Left long finger neuroma, deep ( 5 mm diameter).

2. Reconstruction Left long finger radial digital nerve ( 3 cm )

3. Lateral antebrachial cutaneous nerve harvest autograft- separate site




ASSISTANT:






ANESTHESIA:

LMA.




TOURNIQUET TIME:

49 minutes.




BLOOD LOSS:

Minimal.




FLUIDS:

Per anesthesia record.




OPERATIVE FINDINGS: 4-5mm soft neuroma at long RDN primary repair site.








OPERATIVE SUMMARY IN DETAIL:

Following appropriate informed consent, patient identification, and operative limb, the patient was brought to the operating suite where smooth induction of LMA anesthesia was accomplished by Anesthesiology Service and she  received broad-spectrum IV antibiotic prophylaxis.  The Left upper extremity was prepped and draped in the usual sterile fashion.  Time-out procedure performed.  The limb was exsanguinated with an Esmarch bandage prior to tourniquet inflation to 275 mmHg. A lazy S incision over the Left long finger base incorporating the barely visible traumatic wound was carried.  Blunt dissection was carried down through the subcutaneous tissues with elevation of full-thickness flaps. The RDN neuroma was identified and meticulously dissected and mobilized with findings as above.  The neuroma was sharply excised at healthy, normal appearing levels with healthy margins. The nerve was then reconstructed with a cm LABC autograft harvested from the proximal forearm using microsurgical technique under Loupe magnification. Excellent repair was noted. The neuroma sent to pathology.  Tourniquet was let down.  There was no undue bleeding.  Hemostasis performed using electrocautery. Seprafilm was used to dress the reconstruction as well.  The wounds were reapproximated with nonabsorbable sutures and infiltrated with 0.5% Marcaine for perioperative pain relief.  Sterile nonadherent dressing and extension block splint was applied. she was extubated and transported to the recovery area in stable condition.  There were no intraoperative complications


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## dclark7 (Jun 10, 2015)

Look at 64890 (Nerve graft, includes obtaining graft, single strand hand or foot, up to 4 cm in length) for the repair or the nerve.  The excision of the neuroma would be 64776, per NCCI edits this is bundled with 64890 but a modifier is allowed.  See if these are what you're looking for.


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## MELJNBBRB (Jun 11, 2015)

I like that code selection! Thank you so very much for your time and reply 

M,CCS,CPC


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