# Radical Synovectomy wrist extensor compartment



## Joyce Burchett (Oct 23, 2012)

Pt. has rheumatoid arthrosis involving the Rt wrist; marked extensor tenosynovitis secondary to rheumatoid arthritis; distal radial ulnar joint arthrosis with subluxation ulnar head; extensor tendon rupture involving the 3rd, 4th, 5th digits. Op Procedure: Radical synovectomy Rt wrist extensor compartment; Ulnar head resection; extensor tendon reconstruction digits 3,4,5.  I have looked at CPT 25116, 25119, 25320, 25310,25270.

I am not sure how to code these procedures.  Are there any Ortho Hand Coders that would be willing to look at this op report for coding help.


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## Joyce Burchett (Nov 5, 2012)

*2nd Request--Radical Synovectomy Extensor Tendon*

Op Report: Longitudinal incision made over dorsal aspect wrist. Dissection down through subc tissue. Full thickness flaps elevated off extensor mechanism. Flap of extensor mechanism taken down off of 2nd dorsal compartment & reflected all way over to 6th compartment. This allowed full exposure to extensor compartment & we did a radical synovectomy, debriding synovial tissue from each tendon. We started at the wrist extensors & proceeded to the EIP & into 4th dorsal compartment. Most of pathology was in the 4th dorsal compartment. Large amount of thick reactive synovium debrided sharply with a rongeur all the way down to carpus & we continued onto 5th dorsal compartment. Once adequate debridement we could see rupture of EDQ, EDC to 3,4, and 5. Exposed ulnar head to 5th dorsal compartment & resected with saw blade. Peristeum of ulna was used to reduce this & suture it back into the more palmar position. We then prepared for repair of 3,4 & 5. I sacrificed the EIP(extensor indicis proprius tendon distally & brought it through the the combined 3rd, 4th, & 5th EDC using a pulvertaft weave X4. This gave excellent repair. Extensor retinaculum was reconstructed.  Would this be 25119 & 25270 X3??  Please help.


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## Joyce Burchett (Nov 5, 2012)

*2nd Request--Radical Synovectomy Extensor Tendon*

Op Report: Longitudinal incision made over dorsal aspect wrist. Dissection down through subc tissue. Full thickness flaps elevated off extensor mechanism. Flap of extensor mechanism taken down off of 2nd dorsal compartment & reflected all way over to 6th compartment. This allowed full exposure to extensor compartment & we did a radical synovectomy, debriding synovial tissue from each tendon. We started at the wrist extensors & proceeded to the EIP & into 4th dorsal compartment. Most of pathology was in the 4th dorsal compartment. Large amount of thick reactive synovium debrided sharply with a rongeur all the way down to carpus & we continued onto 5th dorsal compartment. Once adequate debridement we could see rupture of EDQ, EDC to 3,4, and 5. Exposed ulnar head to 5th dorsal compartment & resected with saw blade. Periosteum of ulna was used to reduce this & suture it back into the more palmar position. We then prepared for repair of 3,4 & 5. I sacrificed the EIP(extensor indicis proprius tendon distally & brought it through the the combined 3rd, 4th, & 5th EDC using a pulvertaft weave X4. This gave excellent repair. Extensor retinaculum was reconstructed.  Would this be 25119 & 25270 X3??  Please help.


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