cclarson
Guru
Hello Everyone,
One of our doctors performed a central slip repair (26426) with release of retinacular ligaments and a Fowler Tenotomy. I know how to code the main procedure, but I'm not sure of how to code the minor procedures involved. I was thinking possibly 26460 for the tenotomy? Let me know what you think!
Thank you in advance!
Here is the report:
OPERATIONS PERFORMED:
1. Repair of left long finger central slip.
2. Release of long finger transverse retinacular ligament.
3. Fowler tenotomy, left long finger, terminal extensor tendon.
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 his left upper extremity. Hand table was attached to the left side of the gurney and the upper arm tourniquet was applied. He then underwent prep and drape. After prep and drape, time-out was performed. After routine time-out, we proceeded with the procedure.
I exsanguinated the extremity with an Esmarch bandage and inflated the tourniquet to 250 mmHg. I then excised the original scar just distal to the PIP joint dorsally. After ellipsing the original scar, I extended the incision proximally and distally in a gentle lazy S-shaped incision. Sharp dissection through the skin was followed by elevation of full-thickness skin flaps off the extensor mechanism. The PIP joint was in a flexed position. Passive range of motion allowed to about 15 degrees of the extension. I began to address the injury according to the steps outlined by Curtis.
I initially mobilized the lateral side of the transverse retinacular ligament and attempt to move the lateral band dorsally was improved, but persistent flex posture to the PIP joint. I then resected the transverse retinacular ligaments allowing for the lateral bands to move dorsally. There was still significant tension and inability to fully possibly straighten the PIP joint without significant resistance. I the performed Fowler tenotomy of the terminal extensor tendon with good improvement in the PIP joint extension to neutral. I then used a #15 blade and resected the scar tissue within the central slip overlying the PIP joint. I identified appropriate insertion of the central slip and then used small curette and rongeur to decorticate that area. I placed the guidewire for 2.2- x 4-mm micro corkscrew by Acumed under fluoroscopic guidance into the middle phalanx base at the appropriate insertion of the central slip of the extensor tendon. I confirmed the position on the fluoroscopy and then placed the 2.2- x 4-mm micro corkscrew fully threaded into the middle phalanx with good purchase. I then placed two 3-0 Ethibond to repair the triangular ligament bringing the lateral bands dorsally. The finger was held straight by my assistant, and the central slip was then sewn down using the micro corkscrew. After fully seating the central slip on the dorsal bases of the middle phalanx, I had several sutures into the capsule further reinforcing the repair. I brought the digit through range of motion. There was good full extension of the digit and easily flexed the digit to 90 degrees. The wrist was brought through passive range of motion. There was good tenodesis effect of the digit and restoration of normal cascade of the digits.
I irrigated the wound thoroughly. I closed the incision using 5-0 nylon and washed and dried the extremity. I performed a metacarpal block and applied radial gutter splint. I first applied Xeroform to the incision followed by sterile gauze, sterile Webril, and then, a radial gutter splint and 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.
One of our doctors performed a central slip repair (26426) with release of retinacular ligaments and a Fowler Tenotomy. I know how to code the main procedure, but I'm not sure of how to code the minor procedures involved. I was thinking possibly 26460 for the tenotomy? Let me know what you think!
Thank you in advance!Here is the report:
OPERATIONS PERFORMED:
1. Repair of left long finger central slip.
2. Release of long finger transverse retinacular ligament.
3. Fowler tenotomy, left long finger, terminal extensor tendon.
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 his left upper extremity. Hand table was attached to the left side of the gurney and the upper arm tourniquet was applied. He then underwent prep and drape. After prep and drape, time-out was performed. After routine time-out, we proceeded with the procedure.
I exsanguinated the extremity with an Esmarch bandage and inflated the tourniquet to 250 mmHg. I then excised the original scar just distal to the PIP joint dorsally. After ellipsing the original scar, I extended the incision proximally and distally in a gentle lazy S-shaped incision. Sharp dissection through the skin was followed by elevation of full-thickness skin flaps off the extensor mechanism. The PIP joint was in a flexed position. Passive range of motion allowed to about 15 degrees of the extension. I began to address the injury according to the steps outlined by Curtis.
I initially mobilized the lateral side of the transverse retinacular ligament and attempt to move the lateral band dorsally was improved, but persistent flex posture to the PIP joint. I then resected the transverse retinacular ligaments allowing for the lateral bands to move dorsally. There was still significant tension and inability to fully possibly straighten the PIP joint without significant resistance. I the performed Fowler tenotomy of the terminal extensor tendon with good improvement in the PIP joint extension to neutral. I then used a #15 blade and resected the scar tissue within the central slip overlying the PIP joint. I identified appropriate insertion of the central slip and then used small curette and rongeur to decorticate that area. I placed the guidewire for 2.2- x 4-mm micro corkscrew by Acumed under fluoroscopic guidance into the middle phalanx base at the appropriate insertion of the central slip of the extensor tendon. I confirmed the position on the fluoroscopy and then placed the 2.2- x 4-mm micro corkscrew fully threaded into the middle phalanx with good purchase. I then placed two 3-0 Ethibond to repair the triangular ligament bringing the lateral bands dorsally. The finger was held straight by my assistant, and the central slip was then sewn down using the micro corkscrew. After fully seating the central slip on the dorsal bases of the middle phalanx, I had several sutures into the capsule further reinforcing the repair. I brought the digit through range of motion. There was good full extension of the digit and easily flexed the digit to 90 degrees. The wrist was brought through passive range of motion. There was good tenodesis effect of the digit and restoration of normal cascade of the digits.
I irrigated the wound thoroughly. I closed the incision using 5-0 nylon and washed and dried the extremity. I performed a metacarpal block and applied radial gutter splint. I first applied Xeroform to the incision followed by sterile gauze, sterile Webril, and then, a radial gutter splint and 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.