cclarson
Guru
Hello, I'm trying to figure out which cpt code better fits for the treatment of a scapholunate tear w/ early SLAC wrist.
The doctor states that he did an interposition flap arthroplasty of the radiocarpal space. Typically I'd use 25447, but the radiocarpal space description has me unsure. I might just be overthinking. Any help would be deeply appreciated. He also performed a proximal row carpectomy and posterior interosseous nerve neurectomy, which I coded as 25215/64772.
Here is the body of the op note:
The patient was brought to the operating room and placed supine with the left hand on the hand table. Anesthesia was induced. The arm was then prepped and draped in normal sterile fashion. Timeout was performed and preoperative antibiotics were given.
A longitudinal incision was made over the wrist. We dissected down through the subcutaneous tissues to the extensor retinaculum and this was opened over the third compartment.
The EPL tendon was transposed. The posterior interosseous nerve was then identified and was compressed with a hemostat. We then resected approximately 2 cm of the nerve. We then performed a U-shaped capsulotomy off of the radius. This was elevated off of the proximal row. There was a complete tear of the scapholunate ligament with early arthritis of the radioscaphoid joint and the STT joint. At this point the decision was made to proceed with the proximal row carpectomy. A threaded K-wire was used and scaphoid osteotomy was performed with a saw and osteotomes. The bones were then able to be removed subperiosteally. We then released the lunate and the triquetrum intact and subperiosteal dissection. The wounds were irrigated and the capsule was interposed with 3-0 PDS sutures. There was some mild arthritis of the hamate and so the interposition flap was chosen.
Final fluoroscopic pictures were taken, confirmed good position of the capitate and the lunate fossa without evidence of ulnar translation.
The wounds were irrigated. The extensor retinaculum was repaired with the EPL transposed and then the skin was closed with interrupted nylon sutures. The dorsal wrist splint was applied. The patient tolerated the procedure well without complication.
The doctor states that he did an interposition flap arthroplasty of the radiocarpal space. Typically I'd use 25447, but the radiocarpal space description has me unsure. I might just be overthinking. Any help would be deeply appreciated. He also performed a proximal row carpectomy and posterior interosseous nerve neurectomy, which I coded as 25215/64772.
Here is the body of the op note:
The patient was brought to the operating room and placed supine with the left hand on the hand table. Anesthesia was induced. The arm was then prepped and draped in normal sterile fashion. Timeout was performed and preoperative antibiotics were given.
A longitudinal incision was made over the wrist. We dissected down through the subcutaneous tissues to the extensor retinaculum and this was opened over the third compartment.
The EPL tendon was transposed. The posterior interosseous nerve was then identified and was compressed with a hemostat. We then resected approximately 2 cm of the nerve. We then performed a U-shaped capsulotomy off of the radius. This was elevated off of the proximal row. There was a complete tear of the scapholunate ligament with early arthritis of the radioscaphoid joint and the STT joint. At this point the decision was made to proceed with the proximal row carpectomy. A threaded K-wire was used and scaphoid osteotomy was performed with a saw and osteotomes. The bones were then able to be removed subperiosteally. We then released the lunate and the triquetrum intact and subperiosteal dissection. The wounds were irrigated and the capsule was interposed with 3-0 PDS sutures. There was some mild arthritis of the hamate and so the interposition flap was chosen.
Final fluoroscopic pictures were taken, confirmed good position of the capitate and the lunate fossa without evidence of ulnar translation.
The wounds were irrigated. The extensor retinaculum was repaired with the EPL transposed and then the skin was closed with interrupted nylon sutures. The dorsal wrist splint was applied. The patient tolerated the procedure well without complication.
I'll talk to the doctor concerning this.