maljdcpc
Networker
Requesting coding guidance on left thumb extensor pollicis longus laceration.
CPT codes from MD include: 26418, 11043, 20650
20650 states (separate procedure) however, i am not able to find a code for the pinning (or an appropriate repair code that includes pinning)
Any suggestions or thoughts would be greatly appreciated!
POSTOPERATIVE DIAGNOSES:
1. Left thumb laceration.
2. Left thumb extensor pollicis longus laceration.
PROCEDURES PERFORMED:
1. Irrigation and debridement of left thumb wound
2. Repair of left extensor pollicis longus tendon.
3. Pinning of left thumb IP joint.
The left thumb laceration was extended proximally and distally.
This was a transverse laceration just proximal to
the thumb IP joint. Sharp dissection through skin was followed by blunt
dissection through subcutaneous tissues. Skin edges of the laceration
were carefully debrided. No foreign material was appreciated. Nonviable
tissues were debrided including skin, subcutaneous tissue, and peritendinous
tissue. Flaps were elevated. The EPL was identified.
There was complete laceration in line with the skin laceration
with proximal retraction of the tendon. The tendon was carefully mobilized
and was still somewhat tight. Releases were performed to allow for the
tendon to approximate to its distal end; however, was necessary to keep the
thumb in relative extension and retropulsion. A 0.035 K-wire was advanced
across the thumb IP joint under multiplanar fluoroscopy to help maintain
thumb extension and to limit stress on the repair. Once this was completed,
the pin was cut and the EPL was reapproximated using FiberWire suture in a
modified Kessler fashion with additional Vicryl sutures in a figure-of-eight
fashion. Tendon ends did meet and approximated well, but were under some
tension, which was neutralized by the pinning and the thumb being held in
extension. No graft was deemed necessary at this point. Final debridement was performed.
The pin was cut and a Jurgan ball was placed.
CPT codes from MD include: 26418, 11043, 20650
20650 states (separate procedure) however, i am not able to find a code for the pinning (or an appropriate repair code that includes pinning)
Any suggestions or thoughts would be greatly appreciated!
POSTOPERATIVE DIAGNOSES:
1. Left thumb laceration.
2. Left thumb extensor pollicis longus laceration.
PROCEDURES PERFORMED:
1. Irrigation and debridement of left thumb wound
2. Repair of left extensor pollicis longus tendon.
3. Pinning of left thumb IP joint.
The left thumb laceration was extended proximally and distally.
This was a transverse laceration just proximal to
the thumb IP joint. Sharp dissection through skin was followed by blunt
dissection through subcutaneous tissues. Skin edges of the laceration
were carefully debrided. No foreign material was appreciated. Nonviable
tissues were debrided including skin, subcutaneous tissue, and peritendinous
tissue. Flaps were elevated. The EPL was identified.
There was complete laceration in line with the skin laceration
with proximal retraction of the tendon. The tendon was carefully mobilized
and was still somewhat tight. Releases were performed to allow for the
tendon to approximate to its distal end; however, was necessary to keep the
thumb in relative extension and retropulsion. A 0.035 K-wire was advanced
across the thumb IP joint under multiplanar fluoroscopy to help maintain
thumb extension and to limit stress on the repair. Once this was completed,
the pin was cut and the EPL was reapproximated using FiberWire suture in a
modified Kessler fashion with additional Vicryl sutures in a figure-of-eight
fashion. Tendon ends did meet and approximated well, but were under some
tension, which was neutralized by the pinning and the thumb being held in
extension. No graft was deemed necessary at this point. Final debridement was performed.
The pin was cut and a Jurgan ball was placed.