daniel
True Blue
Hopefully you can share some insight, my question is on CPT 26600 and 25600. Would these closed treatment code apply here, or would this be consider inclusive.
If there not allowed, can please provide a source on why.
Thank you.
26418.F3
26735.51.F3
11012.51
26600.F2
25600.51.LT
Preoperative diagnoses: Left Fourth Metacarpal Fracture, Left Open Fourth Proximal Phalanx Fracture, Left Ring Finger Extensor Tendon Laceration, Left Third Metacarpal Base Fracture, Left Distal Radius Intra-articular Fracture. Right Pilon Fracture.
Postoperative diagnosis: same
Findings: same
Procedures:
- Irrigation and Debridement Open Left Fourth Proximal Phalanx Fracture
- Operative Fixation Left Open Fourth Metacarpal Proximal Phalanx Fracture with .045 K wires x 2
- Closed Treatment of Left Fourth Metacarpal Neck Fracture
- Left Ring Finger Extensor Tendon Laceration Primary Repair
- Closed Treatment of Left Third Metacarpal Base Fracture
- Closed Treatment of Left Distal radius fracture: Application of Sugar Tong: TO BE DONE LATER IN WEEK.
Implants: .045 K wires x 2
Anesthesia: General
Pathology/Specimens: none
Tourniquet Time:
Total Tourniquet Time Documented:
Arm (Left) - 48 minutes
Total: Arm (Left) - 48 minutes
At 250 mm Hg
Blood loss: minimal
Drains/Packs: None
Complications: None
INDICATIONS:
This is a very pleasant xxx year old who sustained the above injuries.
We discussed the benefits and risks of surgery including risks of scar, infection, bleeding, damage to surrounding nerves, continued or increased pain, decreased function and loss of movement, damage to surrounding tissue including vessels, muscles, tendons, bone, ligament and others, continued fracture or malunion or nonunion, extra bone formation or calcium deposits, recurrence of the problem, need for revision surgery, blood clots in the legs and arms, blood clots in the lungs, heart attack, stroke, also risks of anesthesia including nausea, sore throat, headaches, visual changes that include blindness, reaction to medications as well as complications up to and including death.
DESCRIPTION OF PROCEDURE:
The patient was identified in the preoperative care holding area and the procedure, risks, benefits and alternatives were reviewed and discussed with the patient. Informed consent for surgical procedure was reviewed again.
Surgical site was marked. Patient was brought to the operating room. Pressure points were padded and sequential compression devices were applied and turned on.
General anesthesia was induced by the anesthesia team, preoperative antibiotics were administered, I performed a time-out. The patient was placed in the supine position with the hand and arm on a radiolucent table to allow for use of fluoroscopy.
Tourniquet was applied on the operative extremity, the patient extremity was then prepared with chloroprep, the patient was then sterilely prepped and draped per protocol. The operative extremity was exsanguinated, tourniquet was inflated to 250 mmHg.
We addressed the hand laceration first and made curvilinear incisions connecting the traumatic lacerations to examine the extensor tendons, the ring finger extensor laceration was noted to be lacerated, right above the open ring finger proximal phalanx fracture. We irrigated and debrided the open fracture, excisional: skin, subcutaneous, fascia, down to bone level, using 3 Liters of Normal Saline. The ring extensor tendon was repaired with 3-0 Supramid suture. We then used 2 .045 K wires in antegrade fashion to restore the length, alignment and rotation of the fracture, this was confirmed under fluoroscopy. The wound was closed with 3-0 Nylon suture, Tourniquet was deflated. Hemostasis achieved. We treated the fourth metacarpal neck fracture closed as well as the third metacarpal base fracture. We applied a sugartong splint on to stabilize the closed distal radius fracture. We did not address this in the OR due to Emergent nature of Kidney Transplant that was to happen. Arm was placed in a carter pillow block.
The patient was awoken from anesthesia without difficulty, patient was then transferred to the recovery room in stable condition.
If there not allowed, can please provide a source on why.
Thank you.
26418.F3
26735.51.F3
11012.51
26600.F2
25600.51.LT
Preoperative diagnoses: Left Fourth Metacarpal Fracture, Left Open Fourth Proximal Phalanx Fracture, Left Ring Finger Extensor Tendon Laceration, Left Third Metacarpal Base Fracture, Left Distal Radius Intra-articular Fracture. Right Pilon Fracture.
Postoperative diagnosis: same
Findings: same
Procedures:
- Irrigation and Debridement Open Left Fourth Proximal Phalanx Fracture
- Operative Fixation Left Open Fourth Metacarpal Proximal Phalanx Fracture with .045 K wires x 2
- Closed Treatment of Left Fourth Metacarpal Neck Fracture
- Left Ring Finger Extensor Tendon Laceration Primary Repair
- Closed Treatment of Left Third Metacarpal Base Fracture
- Closed Treatment of Left Distal radius fracture: Application of Sugar Tong: TO BE DONE LATER IN WEEK.
Implants: .045 K wires x 2
Anesthesia: General
Pathology/Specimens: none
Tourniquet Time:
Total Tourniquet Time Documented:
Arm (Left) - 48 minutes
Total: Arm (Left) - 48 minutes
At 250 mm Hg
Blood loss: minimal
Drains/Packs: None
Complications: None
INDICATIONS:
This is a very pleasant xxx year old who sustained the above injuries.
We discussed the benefits and risks of surgery including risks of scar, infection, bleeding, damage to surrounding nerves, continued or increased pain, decreased function and loss of movement, damage to surrounding tissue including vessels, muscles, tendons, bone, ligament and others, continued fracture or malunion or nonunion, extra bone formation or calcium deposits, recurrence of the problem, need for revision surgery, blood clots in the legs and arms, blood clots in the lungs, heart attack, stroke, also risks of anesthesia including nausea, sore throat, headaches, visual changes that include blindness, reaction to medications as well as complications up to and including death.
DESCRIPTION OF PROCEDURE:
The patient was identified in the preoperative care holding area and the procedure, risks, benefits and alternatives were reviewed and discussed with the patient. Informed consent for surgical procedure was reviewed again.
Surgical site was marked. Patient was brought to the operating room. Pressure points were padded and sequential compression devices were applied and turned on.
General anesthesia was induced by the anesthesia team, preoperative antibiotics were administered, I performed a time-out. The patient was placed in the supine position with the hand and arm on a radiolucent table to allow for use of fluoroscopy.
Tourniquet was applied on the operative extremity, the patient extremity was then prepared with chloroprep, the patient was then sterilely prepped and draped per protocol. The operative extremity was exsanguinated, tourniquet was inflated to 250 mmHg.
We addressed the hand laceration first and made curvilinear incisions connecting the traumatic lacerations to examine the extensor tendons, the ring finger extensor laceration was noted to be lacerated, right above the open ring finger proximal phalanx fracture. We irrigated and debrided the open fracture, excisional: skin, subcutaneous, fascia, down to bone level, using 3 Liters of Normal Saline. The ring extensor tendon was repaired with 3-0 Supramid suture. We then used 2 .045 K wires in antegrade fashion to restore the length, alignment and rotation of the fracture, this was confirmed under fluoroscopy. The wound was closed with 3-0 Nylon suture, Tourniquet was deflated. Hemostasis achieved. We treated the fourth metacarpal neck fracture closed as well as the third metacarpal base fracture. We applied a sugartong splint on to stabilize the closed distal radius fracture. We did not address this in the OR due to Emergent nature of Kidney Transplant that was to happen. Arm was placed in a carter pillow block.
The patient was awoken from anesthesia without difficulty, patient was then transferred to the recovery room in stable condition.
