Hi all,
One of my hand surgeons performed the below surgery. He is using CPT codes 26480 and 26437.
1. I am unsure if these are the correct codes.
2. If they are the correct codes, would it be appropriate to unbundle them.
The op report is quite lengthy. I really appreciate anyone who is willing to take a look at this and help me out. Thanks in Advance!!
PREOPERATIVE DIAGNOSIS: Chronic radial sagittal band rupture of the
right long finger, symptomatic.
POSTOPERATIVE DIAGNOSIS: Chronic radial sagittal band rupture of the
right long finger, symptomatic.
OPERATIONS AND PROCEDURES PERFORMED:
1. Right long finger sagittal band reconstruction for extensor
realignment.
2. Use of tendon transfer using local tendon autograft from right long
finger extensor tendon.
One of my hand surgeons performed the below surgery. He is using CPT codes 26480 and 26437.
1. I am unsure if these are the correct codes.
2. If they are the correct codes, would it be appropriate to unbundle them.
The op report is quite lengthy. I really appreciate anyone who is willing to take a look at this and help me out. Thanks in Advance!!
PREOPERATIVE DIAGNOSIS: Chronic radial sagittal band rupture of the
right long finger, symptomatic.
POSTOPERATIVE DIAGNOSIS: Chronic radial sagittal band rupture of the
right long finger, symptomatic.
OPERATIONS AND PROCEDURES PERFORMED:
1. Right long finger sagittal band reconstruction for extensor
realignment.
2. Use of tendon transfer using local tendon autograft from right long
finger extensor tendon.
DESCRIPTION OF PROCEDURE: The patient was seen in the preoperative
holding area by the operating surgeon. The operative site, the right
hand and right long finger were marked by the operating surgeon.
Anesthesia also evaluated the patient and felt the patient appropriate
for general anesthesia. She was taken back to the operating room and
placed in the supine position on a regular table. All bony prominences
were well padded. Weight-based dose of IV antibiotics was administered
within one hour prior to the procedure. We began the procedure by using
an Esmarch bandage to exsanguinate the limb and elevating the tourniquet
to 250 mmHg. A radial based incision curvilinear was made overlying the
long finger MP joint through skin only. We carefully dissected through
the subcutaneous tissue and coagulated several traversing venous
branches protecting underlying sensory nerve branches. Skin flaps were
elevated. We continued with our dissection and there was extensive
scarring involving the extensor mechanism as well including overlying
the EDC tendon. We carefully excised some of this scar tissue and the
extensor digitorum communis to the long finger was identified. It was
in the ulnar gutter of the MP joint of the long finger. At this point,
we then carefully released some of the sagittal band and scar tissue on
the ulnar side of the tendon while leaving the remainder of the sagittal
band intact. This allowed us to gently mobilize the tendon into a more
central position, which could be achieved after again releasing some of
the tight and contracted scar tissue that was noted ulnarly. The
remainder of the tendon appeared healthy and intact, the extensor tendon
juncturae tendinum was kept in place and was not cut or repaired
throughout the procedure. We then planned after we felt that our
realignment was possible to perform our tendon transfer and further
realignment. We selected a technique based on a radial based flap from
the extensor digitorum communis. Therefore, we split the tendon
longitudinally of the long finger extensor digitorum communis
approximately 30-40% of the tendon involvement on the radial aspect. A
radial based flap was then created with a segment of the tendon used as
a connected distal based radial tendon graft. We then performed a
Pulvertaft weave distally to prevent splitting further longitudinally of
this graft. This was followed by finding the intermetacarpal ligament
on the radial aspect of the long finger at the MP joint. Using a right
angle, this ligament was carefully cleared of all soft tissue and the
right angle was used to further loop the distal based graft underneath
the intermetacarpal ligament as an anchor point. Finally, we made a
second split more proximally in the tendon and a Pulvertaft weave was
performed again with the tendon pulled upon itself in order to create a
more central position for the tendon. This was done and tension was
carefully created while the tendon was in extension. It was held in
place provisionally at these anchor points from the Pulvertaft weave and
at the intermetacarpal ligament with 3-0 FiberWire suture. At this
point, we then noted that there was appropriate tenodesis and cascade
and appropriate tension. Similarly, with motion of the MP joint in the
long finger, the tendon remained centralized with no evidence of
excessive radial or ulnar deviation. Several more sutures and an
additional Pulvertaft weave was placed in in order to further secure the
tendon and our realignment. At this point, again the tendon appeared to
be well aligned with smooth gliding and all the other fingers appeared
to be appropriately aligned as well. There was improvement of the ulnar
deviation of the long finger as well in to a more appropriate finger
cascade once we had performed the realignment. Next, the wound was
copiously irrigated with normal saline irrigation. Hemostasis was
achieved after tourniquet was deflated followed by placement of several
interrupted nylon sutures for skin closure. All fingers were pink and
warm at the end of the procedure. Sterile dressing and sterile over
wrap was then applied followed by placement to a volar splint with MP
joints in extension, with the DIP joints free, with PIPs essentially
immobilized as well. Buddy taping was applied for the _____ index and
long finger as well. The patient tolerated the procedure well and was
awoken and taken to PACU in stable condition.
holding area by the operating surgeon. The operative site, the right
hand and right long finger were marked by the operating surgeon.
Anesthesia also evaluated the patient and felt the patient appropriate
for general anesthesia. She was taken back to the operating room and
placed in the supine position on a regular table. All bony prominences
were well padded. Weight-based dose of IV antibiotics was administered
within one hour prior to the procedure. We began the procedure by using
an Esmarch bandage to exsanguinate the limb and elevating the tourniquet
to 250 mmHg. A radial based incision curvilinear was made overlying the
long finger MP joint through skin only. We carefully dissected through
the subcutaneous tissue and coagulated several traversing venous
branches protecting underlying sensory nerve branches. Skin flaps were
elevated. We continued with our dissection and there was extensive
scarring involving the extensor mechanism as well including overlying
the EDC tendon. We carefully excised some of this scar tissue and the
extensor digitorum communis to the long finger was identified. It was
in the ulnar gutter of the MP joint of the long finger. At this point,
we then carefully released some of the sagittal band and scar tissue on
the ulnar side of the tendon while leaving the remainder of the sagittal
band intact. This allowed us to gently mobilize the tendon into a more
central position, which could be achieved after again releasing some of
the tight and contracted scar tissue that was noted ulnarly. The
remainder of the tendon appeared healthy and intact, the extensor tendon
juncturae tendinum was kept in place and was not cut or repaired
throughout the procedure. We then planned after we felt that our
realignment was possible to perform our tendon transfer and further
realignment. We selected a technique based on a radial based flap from
the extensor digitorum communis. Therefore, we split the tendon
longitudinally of the long finger extensor digitorum communis
approximately 30-40% of the tendon involvement on the radial aspect. A
radial based flap was then created with a segment of the tendon used as
a connected distal based radial tendon graft. We then performed a
Pulvertaft weave distally to prevent splitting further longitudinally of
this graft. This was followed by finding the intermetacarpal ligament
on the radial aspect of the long finger at the MP joint. Using a right
angle, this ligament was carefully cleared of all soft tissue and the
right angle was used to further loop the distal based graft underneath
the intermetacarpal ligament as an anchor point. Finally, we made a
second split more proximally in the tendon and a Pulvertaft weave was
performed again with the tendon pulled upon itself in order to create a
more central position for the tendon. This was done and tension was
carefully created while the tendon was in extension. It was held in
place provisionally at these anchor points from the Pulvertaft weave and
at the intermetacarpal ligament with 3-0 FiberWire suture. At this
point, we then noted that there was appropriate tenodesis and cascade
and appropriate tension. Similarly, with motion of the MP joint in the
long finger, the tendon remained centralized with no evidence of
excessive radial or ulnar deviation. Several more sutures and an
additional Pulvertaft weave was placed in in order to further secure the
tendon and our realignment. At this point, again the tendon appeared to
be well aligned with smooth gliding and all the other fingers appeared
to be appropriately aligned as well. There was improvement of the ulnar
deviation of the long finger as well in to a more appropriate finger
cascade once we had performed the realignment. Next, the wound was
copiously irrigated with normal saline irrigation. Hemostasis was
achieved after tourniquet was deflated followed by placement of several
interrupted nylon sutures for skin closure. All fingers were pink and
warm at the end of the procedure. Sterile dressing and sterile over
wrap was then applied followed by placement to a volar splint with MP
joints in extension, with the DIP joints free, with PIPs essentially
immobilized as well. Buddy taping was applied for the _____ index and
long finger as well. The patient tolerated the procedure well and was
awoken and taken to PACU in stable condition.