kmuth
Contributor
I need help coding the following: I don't know if I should code 64721,26440 and 26415, one or the other or what quantity.
Right carpal tunnel release, exploration flexor tendons in right palm, side to side repair FDP ring finger to FDP long finger, end to side repair FDP right small finger to right ring finger and long finger complex, end to side repair FDS small to FDS ring. Repair floor of carpal tunnel, reconstruct transverse carpal ligament, synovectomy flexor tendons right palm
Indications: Poor motion right small finger and painful motion right ring finger
Procedure: Next incision was made in the palm extending across the distal wrist flexion crease with a 15 blade. Pickups and then tenotomy scissor were used to resect the subcutaneous tissue down to the antebrachial fascia.. It appeared as though this patient had had a previous carpal tunnel release as there was scar tissue with the transverse carpal ligament used to be. I identified the median nerve proximally and followed it through the scar tissue into the carpal tunnel. I completely decompressed the nerve and the nerve looked fairly normal. I then the flexor tendons and could see immediately there was a heavy synovial build-up around the flexor tendons. I performed a flexor tenosynovectomy of the FDS and FDP tendon tendons to each digit. I then explored the FDS and the FDP to the small. I could see that the FDP to the small was completely ruptured as was the FDS. The FDS was somewhat adherent to the FDS of the ring and that's why she had minimal flexion of the PIP joint to the small finger. The FDS to the ring was intact and normal looking the FDP to the ring was frayed and looked like it was about to rupture. There was a rent in the floor of the carpal tunnel release tendons were going over the bones but the bones did not appear to be sharp. After performing the flexor tenosynovectomy I then repaired the rent in the floor of the carpal tunnel with interrupted 4-0 Vicryl suture. I then repaired the FDP ring to the FDP long side to side using fluoroscopy with loop suture I did this because I felt as though the FDP ring would be rupturing soon if I did not. I then repaired the FDP to the small to the complex that had just created that is the FDP ring and long combined using a tendon weaver with 2 views that were secured with 4-0 Supramid suture. I then performed a end to side repair of the FDS small to the FDS ring again using 2 weaves and 4-0 Supramid loop suture. I checked the flexion of the fingers and the tension of the repair is using the tenodesis effect and it appeared quite good. In order to prevent the tendons from subluxing out of the carpal tunnel I reconstructed the transverse carpal ligament by creating a radially-based flap and suturing it to the ulnar remnant of the transverse carpal ligament. Then irrigated the wounds with copious amounts of saline and repaired the incision with a running 5-0 nylon modified horizontal mattress suture. I then released the tourniquet the patient was placed in a bulky soft bandage and a dorsal block splint. She tolerated the procedure well and was sent to the discharge area in stable condition
Right carpal tunnel release, exploration flexor tendons in right palm, side to side repair FDP ring finger to FDP long finger, end to side repair FDP right small finger to right ring finger and long finger complex, end to side repair FDS small to FDS ring. Repair floor of carpal tunnel, reconstruct transverse carpal ligament, synovectomy flexor tendons right palm
Indications: Poor motion right small finger and painful motion right ring finger
Procedure: Next incision was made in the palm extending across the distal wrist flexion crease with a 15 blade. Pickups and then tenotomy scissor were used to resect the subcutaneous tissue down to the antebrachial fascia.. It appeared as though this patient had had a previous carpal tunnel release as there was scar tissue with the transverse carpal ligament used to be. I identified the median nerve proximally and followed it through the scar tissue into the carpal tunnel. I completely decompressed the nerve and the nerve looked fairly normal. I then the flexor tendons and could see immediately there was a heavy synovial build-up around the flexor tendons. I performed a flexor tenosynovectomy of the FDS and FDP tendon tendons to each digit. I then explored the FDS and the FDP to the small. I could see that the FDP to the small was completely ruptured as was the FDS. The FDS was somewhat adherent to the FDS of the ring and that's why she had minimal flexion of the PIP joint to the small finger. The FDS to the ring was intact and normal looking the FDP to the ring was frayed and looked like it was about to rupture. There was a rent in the floor of the carpal tunnel release tendons were going over the bones but the bones did not appear to be sharp. After performing the flexor tenosynovectomy I then repaired the rent in the floor of the carpal tunnel with interrupted 4-0 Vicryl suture. I then repaired the FDP ring to the FDP long side to side using fluoroscopy with loop suture I did this because I felt as though the FDP ring would be rupturing soon if I did not. I then repaired the FDP to the small to the complex that had just created that is the FDP ring and long combined using a tendon weaver with 2 views that were secured with 4-0 Supramid suture. I then performed a end to side repair of the FDS small to the FDS ring again using 2 weaves and 4-0 Supramid loop suture. I checked the flexion of the fingers and the tension of the repair is using the tenodesis effect and it appeared quite good. In order to prevent the tendons from subluxing out of the carpal tunnel I reconstructed the transverse carpal ligament by creating a radially-based flap and suturing it to the ulnar remnant of the transverse carpal ligament. Then irrigated the wounds with copious amounts of saline and repaired the incision with a running 5-0 nylon modified horizontal mattress suture. I then released the tourniquet the patient was placed in a bulky soft bandage and a dorsal block splint. She tolerated the procedure well and was sent to the discharge area in stable condition
