TTcpc
Guru
Hello,
I am learning ortho procedures for our pediatric hand surgeon and have read this op note over and over and am to the point of confusion. Can someone assist me with what codes you are getting? The MD requested 26471 and 26483; however I'm missing where a graft was used.
Reason for surgery: S/P polydactyl excision 2018 with resulted in Z deformity, which is progressing with absent IP extension and instability at the IP joint of left thumb. Patient presents at this point for reconstruction of the thumb to provide better tip pinch and grasp activity.
TITLE OF PROCEDURE:
1. Left thumb extensor indicis proprius transfer to extensor pollicis
longus.
2. Left thumb radial and ulnar collateral ligament reconstruction to bone,
proximal phalanx.
Care was taken to identify the IP joint. A curvilinear incision was made
on the dorsal aspect of the left thumb IP joint. Dissection was taken down
to the EPL tendon, which was noted to attach on the slightly ulnar aspect
at the joint with continuation to the distal phalanx, but dense adhesions
across the joint capsule and on the proximal phalanx. A Beaver blade was
used to elevate and free all of these adhesions from the MCP to the
insertion on the DIP joint. At this point, traction on the IP joint
allowed for extension of the IP joint with pole on the EPL tendon. A
second incision was then made measuring 2 cm longitudinally over the left
index finger MCP joint. Dissection was taken down to identify EIP and EPL.
The ulnar EIP tendon was freed and retraction was placed on it to confirm
that it was the EIP tendon. Another 2 cm transverse incision was made just
distal to the extensor retinaculum on the dorsum of the wrist. Extensor
tendons were identified and, again, the EIP was identified separate from
the extensor digitorum communis. The EIP was then transected just proximal
to the sagittal band at the MCP joint of the index finger dorsally. It was
then retracted out of the wound at the dorsal wrist incision. Once the EIP
was free of all adhesions, a tunnel was made from the dorsal wrist incision
to the dorsal IP joint thumb incision. The tendon was then placed down
that tunnel to the IP joint. The EIP tendon was then sutured into the EPL
tendon at the level of the distal phalanx and then sutured along the side
of the EPL tendon at the level of the proximal phalanx. Tenodesis effect
was then monitored and thumb IP joint extension was visualized with wrist
flexion and IP joint flexion was visualized with wrist extension. A 0.062
K-wire was then used to drill a hole across the distal aspect of the
proximal phalanx and a 2-0 Vicryl suture was placed across his hole. Next,
4-0 Mersilene sutures were then placed in the radial collateral ligament,
which was sutured down to this 2-0 Vicryl suture, which was then tensioned
through the hole placed through the bone. This provided significant
stabilization of the radial collateral ligament. A 4-0 Ethibond was then
again used to suture the ulnar collateral ligament, which was again sutured
down to the Vicryl coming through the bone and tensioned. This provided
stabilization of the IP joints of the thumb with a minimal amount of
excursion. A second 4-0 Mersilene suture was then used to augment both
repairs to local soft tissue radial and ulnar collateral ligaments. Again,
the tenodesis effect was monitored to ensure that there was active passive
flexion and extension at the IP joint with wrist motion. Wounds were
irrigated and closed with 4-0 Vicryl and 5-0 Monocryl sutures.
I am learning ortho procedures for our pediatric hand surgeon and have read this op note over and over and am to the point of confusion. Can someone assist me with what codes you are getting? The MD requested 26471 and 26483; however I'm missing where a graft was used.
Reason for surgery: S/P polydactyl excision 2018 with resulted in Z deformity, which is progressing with absent IP extension and instability at the IP joint of left thumb. Patient presents at this point for reconstruction of the thumb to provide better tip pinch and grasp activity.
TITLE OF PROCEDURE:
1. Left thumb extensor indicis proprius transfer to extensor pollicis
longus.
2. Left thumb radial and ulnar collateral ligament reconstruction to bone,
proximal phalanx.
Care was taken to identify the IP joint. A curvilinear incision was made
on the dorsal aspect of the left thumb IP joint. Dissection was taken down
to the EPL tendon, which was noted to attach on the slightly ulnar aspect
at the joint with continuation to the distal phalanx, but dense adhesions
across the joint capsule and on the proximal phalanx. A Beaver blade was
used to elevate and free all of these adhesions from the MCP to the
insertion on the DIP joint. At this point, traction on the IP joint
allowed for extension of the IP joint with pole on the EPL tendon. A
second incision was then made measuring 2 cm longitudinally over the left
index finger MCP joint. Dissection was taken down to identify EIP and EPL.
The ulnar EIP tendon was freed and retraction was placed on it to confirm
that it was the EIP tendon. Another 2 cm transverse incision was made just
distal to the extensor retinaculum on the dorsum of the wrist. Extensor
tendons were identified and, again, the EIP was identified separate from
the extensor digitorum communis. The EIP was then transected just proximal
to the sagittal band at the MCP joint of the index finger dorsally. It was
then retracted out of the wound at the dorsal wrist incision. Once the EIP
was free of all adhesions, a tunnel was made from the dorsal wrist incision
to the dorsal IP joint thumb incision. The tendon was then placed down
that tunnel to the IP joint. The EIP tendon was then sutured into the EPL
tendon at the level of the distal phalanx and then sutured along the side
of the EPL tendon at the level of the proximal phalanx. Tenodesis effect
was then monitored and thumb IP joint extension was visualized with wrist
flexion and IP joint flexion was visualized with wrist extension. A 0.062
K-wire was then used to drill a hole across the distal aspect of the
proximal phalanx and a 2-0 Vicryl suture was placed across his hole. Next,
4-0 Mersilene sutures were then placed in the radial collateral ligament,
which was sutured down to this 2-0 Vicryl suture, which was then tensioned
through the hole placed through the bone. This provided significant
stabilization of the radial collateral ligament. A 4-0 Ethibond was then
again used to suture the ulnar collateral ligament, which was again sutured
down to the Vicryl coming through the bone and tensioned. This provided
stabilization of the IP joints of the thumb with a minimal amount of
excursion. A second 4-0 Mersilene suture was then used to augment both
repairs to local soft tissue radial and ulnar collateral ligaments. Again,
the tenodesis effect was monitored to ensure that there was active passive
flexion and extension at the IP joint with wrist motion. Wounds were
irrigated and closed with 4-0 Vicryl and 5-0 Monocryl sutures.