afryberger
Networker
64721 and 25320? Do I bill for the suturing of the ligament after the release? AAPC coder description states: "The ligament is surgically divided to release pressure on the median nerve. Care is taken to ensure safety of the median nerve and the tendons surrounding it. A layered closure of the incisional wound is then made." Or would the suturing of the ligament be part of the layered closure??
PROCEDURE:
The patient was brought to the operating room where sedation was administered. A median nerve block was administered, a tourniquet was placed on the patient's left upper extremity and the left upper extremity was prepped and draped in the appropriate sterile manner. Tourniquet was inflated. A curvilinear incision, approximately 4 cm in length was made, in line with the radial aspect of the ring finger, ending 4 mm distal to the distal wrist crease. Blunt dissection was performed, and the palmar aponeurosis was visualized. It was then incised, and retracted out of the way. The transverse carpal ligament was then visualized, and under direct visualization, the transverse carpal ligament was sharply incised in a step cut manner.
Using a Senn retractor, the antebrachial fascia was visualized proximally, and under direct visualization the antebrachial fascia was completely incised using iris scissors. Complete release was confirmed by visualization, as well as the surgeon placing the small finger proximally in the wound, and no bands, or areas of compression were palpated. Next attention was directed distally. The distal portion of the transverse carpal ligament was released, and the digital branches of the median nerve visualized. Next, attention was directed to the motor branch. It was visualized, and noted to be intact. Next attention was redirected to the transverse carpal ligament. The ends were then reconstructed with 4-0 Vicryl, maintainindg grip strength and preventing bowstringing. After the reconstruction, examination showed full free tendon gliding and no compression of the nerve. Tourniquet was released, there was no active bleeding, and all other bleeding was stopped using bipolar cautery. The wound was closed 4-0 nylon sutures, followed by a sterile dressing, followed by a volar splint. The patient was then transferred to recovery room in stable condition.
PROCEDURE:
The patient was brought to the operating room where sedation was administered. A median nerve block was administered, a tourniquet was placed on the patient's left upper extremity and the left upper extremity was prepped and draped in the appropriate sterile manner. Tourniquet was inflated. A curvilinear incision, approximately 4 cm in length was made, in line with the radial aspect of the ring finger, ending 4 mm distal to the distal wrist crease. Blunt dissection was performed, and the palmar aponeurosis was visualized. It was then incised, and retracted out of the way. The transverse carpal ligament was then visualized, and under direct visualization, the transverse carpal ligament was sharply incised in a step cut manner.
Using a Senn retractor, the antebrachial fascia was visualized proximally, and under direct visualization the antebrachial fascia was completely incised using iris scissors. Complete release was confirmed by visualization, as well as the surgeon placing the small finger proximally in the wound, and no bands, or areas of compression were palpated. Next attention was directed distally. The distal portion of the transverse carpal ligament was released, and the digital branches of the median nerve visualized. Next, attention was directed to the motor branch. It was visualized, and noted to be intact. Next attention was redirected to the transverse carpal ligament. The ends were then reconstructed with 4-0 Vicryl, maintainindg grip strength and preventing bowstringing. After the reconstruction, examination showed full free tendon gliding and no compression of the nerve. Tourniquet was released, there was no active bleeding, and all other bleeding was stopped using bipolar cautery. The wound was closed 4-0 nylon sutures, followed by a sterile dressing, followed by a volar splint. The patient was then transferred to recovery room in stable condition.