cclarson
Guru
Hello Everyone,
I am having trouble coding the exploration of a fifth extensor compartment. I'm thinking of possibly an arthrotomy code? However, the doctor repairs the EDQ within the fifth compartment with a fiberwire. How should I code this?
POSTOPERATIVE DIAGNOSIS:
1. Left triangular fibrocartilage complex type D tear.
2. Attritional rupture of left extensor digiti quinti.
OPERATION PERFORMED:
1. Left wrist arthroscopy with triangular fibrocartilage complex debridement.
2. Exploration of left fifth extensor compartment.
DESCRIPTION OF PROCEDURE:
The patient was met in the holding area. The surgical site was marked and confirmed. Questions were answered. We then proceeded to the OR. Once in the OR, the patient underwent induction of general anesthesia, followed by placement of a LMA. Once the LMA was secured, the bed was rotated to allow better access to the left upper extremity. Hand table was attached to the left side of the bed and upper arm tourniquet was applied. The patient underwent prep and drape. After prep and drape time out was performed. After routine timeout, we proceeded with the procedure.
I exsanguinated the extremity with an Esmarch bandage and inflated the tourniquet to 250 mmHg. I then placed the arm into a traction tower with finger traps, placing 10 pounds of traction on the wrist. I entered the 3-4 interval and placed the camera within. There were some degenerative changes within. I was able to visualize thinning of the meniscal homologue of the TFCC with a partial thickness tearing of the meniscal homologue. I used a needle to localize my 6R working portal. I then bluntly dissected opening the 6R working portal introducing the shaver. I shaved the type D tear of the left TFCC.
Prior to roll back, the patient and I discussed his wrist. He complained of pain and limited range of motion of the small finger. I opened his original scar overlying the fifth extensor compartment and dissected bluntly, exposing the fifth extensor compartment. I was able to identify a thin scarred EDQ tendon within the base of the fifth extensor compartment that did not freely move on traction. I dissected along the EDQ tendon and discovered that it had ruptured due to slightly high riding ulnar head. I debrided portions of the tendon and identified his original suturing of the TFCC. I removed the Prolene sutures and resutured his TFCC tear periphery with 4-0 FiberWire. I then repaired the fifth extensor compartment using FiberWire.
The tourniquet was deflated. I irrigated the wound thoroughly. I closed the incisions using interrupted nylon. I washed and dried the extremity. I infiltrated local anesthetic into the incision sites and then applied dressings of Xeroform, sterile 4x4s, sterile Webril, and a volar splint of plaster overwrapped with an Ace bandage. All digits were pink and viable at the conclusion. The patient was awakened, extubated, and taken to the recovery room. He arrived in the recovery room in stable condition still under the influence of general anesthesia. All counts correct x2
I am having trouble coding the exploration of a fifth extensor compartment. I'm thinking of possibly an arthrotomy code? However, the doctor repairs the EDQ within the fifth compartment with a fiberwire. How should I code this?
POSTOPERATIVE DIAGNOSIS:
1. Left triangular fibrocartilage complex type D tear.
2. Attritional rupture of left extensor digiti quinti.
OPERATION PERFORMED:
1. Left wrist arthroscopy with triangular fibrocartilage complex debridement.
2. Exploration of left fifth extensor compartment.
DESCRIPTION OF PROCEDURE:
The patient was met in the holding area. The surgical site was marked and confirmed. Questions were answered. We then proceeded to the OR. Once in the OR, the patient underwent induction of general anesthesia, followed by placement of a LMA. Once the LMA was secured, the bed was rotated to allow better access to the left upper extremity. Hand table was attached to the left side of the bed and upper arm tourniquet was applied. The patient underwent prep and drape. After prep and drape time out was performed. After routine timeout, we proceeded with the procedure.
I exsanguinated the extremity with an Esmarch bandage and inflated the tourniquet to 250 mmHg. I then placed the arm into a traction tower with finger traps, placing 10 pounds of traction on the wrist. I entered the 3-4 interval and placed the camera within. There were some degenerative changes within. I was able to visualize thinning of the meniscal homologue of the TFCC with a partial thickness tearing of the meniscal homologue. I used a needle to localize my 6R working portal. I then bluntly dissected opening the 6R working portal introducing the shaver. I shaved the type D tear of the left TFCC.
Prior to roll back, the patient and I discussed his wrist. He complained of pain and limited range of motion of the small finger. I opened his original scar overlying the fifth extensor compartment and dissected bluntly, exposing the fifth extensor compartment. I was able to identify a thin scarred EDQ tendon within the base of the fifth extensor compartment that did not freely move on traction. I dissected along the EDQ tendon and discovered that it had ruptured due to slightly high riding ulnar head. I debrided portions of the tendon and identified his original suturing of the TFCC. I removed the Prolene sutures and resutured his TFCC tear periphery with 4-0 FiberWire. I then repaired the fifth extensor compartment using FiberWire.
The tourniquet was deflated. I irrigated the wound thoroughly. I closed the incisions using interrupted nylon. I washed and dried the extremity. I infiltrated local anesthetic into the incision sites and then applied dressings of Xeroform, sterile 4x4s, sterile Webril, and a volar splint of plaster overwrapped with an Ace bandage. All digits were pink and viable at the conclusion. The patient was awakened, extubated, and taken to the recovery room. He arrived in the recovery room in stable condition still under the influence of general anesthesia. All counts correct x2