Below is my physician's op note for CMC. I need some coding direction if this should be coded as 25447 or 25448 and why? Any help will be greatly appreciated. Thanks!
PROCEDURES PERFORMED:
1. Left thumb CMC arthroplasty with internal brace.
2. Left wrist FCR weave
PROCEDURE:
The patient was seen preoperatively, site was marked and
verified. Preoperative antibiotics were given. She was taken back to the OR. Time-out was taken at the
beginning of the procedure. The arm was exsanguinated. The tourniquet was inflated. A transverse
incision was made in the mid forearm. We carefully dissected down and transected the FCR tendon. A
separate incision was made along the radial aspect of the wrist, carefully dissected down protecting the
cutaneous nerve branches. First dorsal compartment was released. We then placed a retractor between
the tendons and identified the radial artery. This was protected through the remainder of the procedure.
The trapezium was then exposed and removed with osteotome, rongeur and curette. The joint between
the scaphoid and trapezoid was examined and appeared to be healthy. The FCR tendon was then
withdrawn from the base of the wound. We placed a Arthrex FiberTak anchor across the base of the
index metacarpal. Once this was secured, the FiberTape was then secured to the base of the thumb
metacarpal. She did have osteoporotic bone. In the process of securing the FiberTape, the screw itself
would not see appropriately, but the foretip became large and actually secured the FiberTape quite nicely.
The thumb appeared stable and at this point, the FiberTape was cut. The FCR tendon was secured to the
base of the thumb metacarpal as well using 2-0 PDS. Remainder of the FCR tendon was sutured together
with 3-0 Vicryl, placed into the space left by the trapeziectomy. The capsule was then closed with Vicryl,
skin was closed with Monocryl. She was placed in a thumb spica splint and tolerated the procedure well.
PROCEDURES PERFORMED:
1. Left thumb CMC arthroplasty with internal brace.
2. Left wrist FCR weave
PROCEDURE:
The patient was seen preoperatively, site was marked and
verified. Preoperative antibiotics were given. She was taken back to the OR. Time-out was taken at the
beginning of the procedure. The arm was exsanguinated. The tourniquet was inflated. A transverse
incision was made in the mid forearm. We carefully dissected down and transected the FCR tendon. A
separate incision was made along the radial aspect of the wrist, carefully dissected down protecting the
cutaneous nerve branches. First dorsal compartment was released. We then placed a retractor between
the tendons and identified the radial artery. This was protected through the remainder of the procedure.
The trapezium was then exposed and removed with osteotome, rongeur and curette. The joint between
the scaphoid and trapezoid was examined and appeared to be healthy. The FCR tendon was then
withdrawn from the base of the wound. We placed a Arthrex FiberTak anchor across the base of the
index metacarpal. Once this was secured, the FiberTape was then secured to the base of the thumb
metacarpal. She did have osteoporotic bone. In the process of securing the FiberTape, the screw itself
would not see appropriately, but the foretip became large and actually secured the FiberTape quite nicely.
The thumb appeared stable and at this point, the FiberTape was cut. The FCR tendon was secured to the
base of the thumb metacarpal as well using 2-0 PDS. Remainder of the FCR tendon was sutured together
with 3-0 Vicryl, placed into the space left by the trapeziectomy. The capsule was then closed with Vicryl,
skin was closed with Monocryl. She was placed in a thumb spica splint and tolerated the procedure well.