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I code for an ASC and am leaning more towards CPT codes 25447 & 25312 for the procedure below, however the physicians office authorized 25447 & 26480. I originally thought 25312 due to the creation of a separate incision& harvesting of the tendon as the graft "The FCR tendon was harvested from these two incisions and pulled into the distal wound" Any advise would be appreciated. Thank you.
POSTOPERATIVE DIAGNOSES: 1. Left thumb carpometacarpal joint osteoarthritis.2. Left wrist scaphotrapeziotrapezoidal joint osteoarthritis.
OPERATIONS PERFORMED: 1. Left thumb carpometacarpal joint interposition arthroplasty.2. Left wrist scaphotrapeziotrapezoidal joint resection arthroplasty.3. Harvest left flexor carpi radialis tendon from separate incision.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and placed in the supine position on the operating room table. IV sedation was administered. A regional anesthetic had been administered. The left upper extremity was prepped and draped in the usual sterile manner. The tourniquet was inflated to 250 mmHg pressure. A longitudinal incision was made over the left thumb CMC joint. Dissection was carried down through the skin and subcutaneous tissues. The branches of the radial and sensory nerves were identified and protected. The radial artery was identified and protected. The capsule overlying the CMC joint was spilt, and the underlying trapezium was visualized. It was cut into four and removed. A hole was made at the base of the first metacarpal. The ST joint was then inspected. It was markedly arthritic. A saw was used to cut off the distal end of the scaphoid and the proximal end of the trapezoid. This opened up the space nicely. The wound was washed out vigorously. Hemostasis was obtained. Two separate incisions were made in the volar forearm. The FCR tendon was harvested from these two incisions and pulled into the distal wound. The tendon was pulled through the hole at the base of the first metacarpal and tied to itself at the base of the arthroplasty space using a 3-0 Ethibond. The remainder of the tendon was rolled up as an arthroplasty spacer and placed within the joint. The joint was closed firmly with 3-0 Ethibond. The wound was washed out vigorously. Hemostasis was obtained. The skin was closed with 4-0 Monocryl sutures followed by Benzoin, Steri-Strips, 4x4s, Sof-Rol, and a well-padded thumb spica splint.
POSTOPERATIVE DIAGNOSES: 1. Left thumb carpometacarpal joint osteoarthritis.2. Left wrist scaphotrapeziotrapezoidal joint osteoarthritis.
OPERATIONS PERFORMED: 1. Left thumb carpometacarpal joint interposition arthroplasty.2. Left wrist scaphotrapeziotrapezoidal joint resection arthroplasty.3. Harvest left flexor carpi radialis tendon from separate incision.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and placed in the supine position on the operating room table. IV sedation was administered. A regional anesthetic had been administered. The left upper extremity was prepped and draped in the usual sterile manner. The tourniquet was inflated to 250 mmHg pressure. A longitudinal incision was made over the left thumb CMC joint. Dissection was carried down through the skin and subcutaneous tissues. The branches of the radial and sensory nerves were identified and protected. The radial artery was identified and protected. The capsule overlying the CMC joint was spilt, and the underlying trapezium was visualized. It was cut into four and removed. A hole was made at the base of the first metacarpal. The ST joint was then inspected. It was markedly arthritic. A saw was used to cut off the distal end of the scaphoid and the proximal end of the trapezoid. This opened up the space nicely. The wound was washed out vigorously. Hemostasis was obtained. Two separate incisions were made in the volar forearm. The FCR tendon was harvested from these two incisions and pulled into the distal wound. The tendon was pulled through the hole at the base of the first metacarpal and tied to itself at the base of the arthroplasty space using a 3-0 Ethibond. The remainder of the tendon was rolled up as an arthroplasty spacer and placed within the joint. The joint was closed firmly with 3-0 Ethibond. The wound was washed out vigorously. Hemostasis was obtained. The skin was closed with 4-0 Monocryl sutures followed by Benzoin, Steri-Strips, 4x4s, Sof-Rol, and a well-padded thumb spica splint.