SirCodesAlot07
Networker
I am having a little bit of a hard time with coding this report. My doctor wants me to code endoscopic since he still had to open the blade but I disagree. He converted to open therefore you only code open, correct? How would you code this report? Also he performed an excision of a cyst. Should I code that separately?
Incision made transversely at the wrist crease. The forearm fascia was elevated. We carefully dissected and released the forearm fascia proximally, distally it was tagged. Subsynovial dissection was performed. We dilated the canal and placed the endoscope. We could see the endoscope was not tight necessarily, but the median nerve was scarred to the radial flap. We therefore released it proximally with the endoscope and did not feel that it was safe to go distally and converted to an open. An extensile incision was then made. We carefully elevated skin flaps. Electrocautery was used for hemostasis. We dissected down to the transverse carpal ligament and carefully released it. We then mobilized the median nerve off of the radial flap. We carefully dissected and released the scar around the median nerve. We removed the synovium from around the tendons on the radial and ulnar side. There was a significant narrowing of the median nerve right where the scarring occurred. We released the tourniquet to see if it pinked up and it pinked up a little bit, but not normally. Wounds were irrigated. They were closed with 5-0 nylon horizontal mattress sutures. A dorsal incision was made over the ganglion cyst dorsally. We dissected down, opened up the fourth extensor compartment. The long finger extensor tendon had an intratendinous cyst. We opened up the tendon longitudinally and excised the cyst and frayed tendon that was inside the tendon. We then repaired the tendon with a 6-0 locking suture. Tourniquet was never elevated during this part. Wounds were irrigated and closed with 5-0 nylon horizontal mattress suture. Adaptic gauze, Webril, volar wrist splint, and Ace wraps applied. The patient tolerated the procedure well and went to the recovery room in stable condition.
Incision made transversely at the wrist crease. The forearm fascia was elevated. We carefully dissected and released the forearm fascia proximally, distally it was tagged. Subsynovial dissection was performed. We dilated the canal and placed the endoscope. We could see the endoscope was not tight necessarily, but the median nerve was scarred to the radial flap. We therefore released it proximally with the endoscope and did not feel that it was safe to go distally and converted to an open. An extensile incision was then made. We carefully elevated skin flaps. Electrocautery was used for hemostasis. We dissected down to the transverse carpal ligament and carefully released it. We then mobilized the median nerve off of the radial flap. We carefully dissected and released the scar around the median nerve. We removed the synovium from around the tendons on the radial and ulnar side. There was a significant narrowing of the median nerve right where the scarring occurred. We released the tourniquet to see if it pinked up and it pinked up a little bit, but not normally. Wounds were irrigated. They were closed with 5-0 nylon horizontal mattress sutures. A dorsal incision was made over the ganglion cyst dorsally. We dissected down, opened up the fourth extensor compartment. The long finger extensor tendon had an intratendinous cyst. We opened up the tendon longitudinally and excised the cyst and frayed tendon that was inside the tendon. We then repaired the tendon with a 6-0 locking suture. Tourniquet was never elevated during this part. Wounds were irrigated and closed with 5-0 nylon horizontal mattress suture. Adaptic gauze, Webril, volar wrist splint, and Ace wraps applied. The patient tolerated the procedure well and went to the recovery room in stable condition.