jhaleycoder
Networker
Hi- Can anyone help me with coding this surgery. I am leaning towards CPT 25310, 25270
The patient identification, operative site, and operative procedure were verified with the patient preoperatively in the holding area and again at the safety pause in the operating room. The patient was transferred to the operating room in a supine position on a stretcher. The right upper extremity was extended onto an arm table and a well-padded upper arm tourniquet was placed. The anesthesia team administered some sedation as well as a Bier block to the right upper extremity. The operative extremity was then prepped and draped using the standard sterile technique with Betadine. A proposed incision line was marked over the dorsal aspect of the wrist. This was an oblique incision centered over Lister's tubercle along the course of the EPL tendon measuring approximately 4 cm in length. A timeout was performed and all were in agreement. A #15 blade was used to incise the skin. Blunt dissection was used to pass down through the subcutaneous tissues. Superficial neurovascular structures were identified and protected. Once the third dorsal compartment sheath was identified adjacent to Lister's tubercle, the thumb was moved passively in flexion and extension to verify the correct site. The tendon sheath was opened using a deep #15 blade. Dissecting scissors were used to release the tendon sheath proximally to the level of the mid forearm and distally to the level of the thumb CMC joint. The tendon was then inspected. There was 20% attritional rupture of the EPL tendon with significant fraying. This was debrided with forceps and scissors until the surface of the tendon was smooth. The EPL tendon was thickened consistent with chronic tendinosis. The EPL tendon was then transposed extra-retinacularly. The wound was copiously irrigated. There was noted to be no kinking or binding of the EPL tendon in its newly transposed position. The EPL tendon sheath was closed with interrupted 4-0 Vicryl sutures followed by a running locking 4-0 Vicryl suture to ensure that the EPL tendon would remain transposed outside of the third dorsal compartment sheath. The subcutaneous skin layers were closed with 4-0 Vicryl sutures and the skin was closed with a running 4-0 Stratafix suture. A dry sterile bulky nonadherent dressing was placed over the incision and secured in place with an Ace wrap. The tourniquet was released with immediate return of blood flow to the fingertips. The procedures were uncomplicated. The counts were correct. The patient tolerated the procedures well and was transferred to the PACU in stable condition.
The patient identification, operative site, and operative procedure were verified with the patient preoperatively in the holding area and again at the safety pause in the operating room. The patient was transferred to the operating room in a supine position on a stretcher. The right upper extremity was extended onto an arm table and a well-padded upper arm tourniquet was placed. The anesthesia team administered some sedation as well as a Bier block to the right upper extremity. The operative extremity was then prepped and draped using the standard sterile technique with Betadine. A proposed incision line was marked over the dorsal aspect of the wrist. This was an oblique incision centered over Lister's tubercle along the course of the EPL tendon measuring approximately 4 cm in length. A timeout was performed and all were in agreement. A #15 blade was used to incise the skin. Blunt dissection was used to pass down through the subcutaneous tissues. Superficial neurovascular structures were identified and protected. Once the third dorsal compartment sheath was identified adjacent to Lister's tubercle, the thumb was moved passively in flexion and extension to verify the correct site. The tendon sheath was opened using a deep #15 blade. Dissecting scissors were used to release the tendon sheath proximally to the level of the mid forearm and distally to the level of the thumb CMC joint. The tendon was then inspected. There was 20% attritional rupture of the EPL tendon with significant fraying. This was debrided with forceps and scissors until the surface of the tendon was smooth. The EPL tendon was thickened consistent with chronic tendinosis. The EPL tendon was then transposed extra-retinacularly. The wound was copiously irrigated. There was noted to be no kinking or binding of the EPL tendon in its newly transposed position. The EPL tendon sheath was closed with interrupted 4-0 Vicryl sutures followed by a running locking 4-0 Vicryl suture to ensure that the EPL tendon would remain transposed outside of the third dorsal compartment sheath. The subcutaneous skin layers were closed with 4-0 Vicryl sutures and the skin was closed with a running 4-0 Stratafix suture. A dry sterile bulky nonadherent dressing was placed over the incision and secured in place with an Ace wrap. The tourniquet was released with immediate return of blood flow to the fingertips. The procedures were uncomplicated. The counts were correct. The patient tolerated the procedures well and was transferred to the PACU in stable condition.
