MUS
New
Hello,
I need help with the procedures. I'm split between 25405 and 25391 and also is lengthening of brachioradialis inclusive or coded separately. Kindly advise. Thank you.
My final codes are 25310 and 25405 or 25391.
POSTOPERATIVE DIAGNOSES:
1. Left distal radius fracture shortening malunion.
2. Left brachioradialis tendon acute shortening contracture.
OPERATIONS PERFORMED:
1. Subcutaneous transplantation of the EPL, left wrist. (CPT:25310)
2. Lengthening of radius with autograft and allograft, left distal radius.(25405 or 25391)?
3. Lengthening tenotomy of the brachioradialis, left distal radius.
The procedure was begun with a dorsal approach to the left distal radius
centered over Lister's tubercle. Careful dissection was carried down to the
distal radius itself. Care was taken to identify and protect branches of the
radial sensory nerve.
Next, a subcutaneous transplantation of the EPL was performed. The EPL was
released from the third dorsal compartment. It was then transposed radially
to a subcutaneous position. Care was taken to ensure the tendon was not
constricting the fascia both proximally and distally.
Next, a dorsal approach to the distal radius was performed by elevating the
second dorsal compartment off the distal radius radially and then elevating
the fourth dorsal compartment off the distal radius ulnarly.
Next, the distal radius malunion site was marked with a 1.6 mm K-wire.
Fluoroscopic imaging was used to confirm the location not only of the
fracture, but of the planned osteotomy for lengthening. Next, multiple K-
wires were placed from dorsal to volar across the distal radius to facilitate
osteoclasis. Next, an osteotome was used to create the osteotomy at the
distal radius. Next, the distal radius was lengthened approximately 6 mm
ulnarly and approximately 8 to 9 mm radially. A freeze-dried cancellous
allograft bone graft was contoured and impacted into position for this
lengthening.
Prior to the lengthening, the brachioradialis was assessed. I was not able to
lengthen the radius adequately radially with the brachioradialis acute
shortening contracture present. As a result, a lengthening tenotomy of the
brachioradialis was performed. The tendon was released and allowed to rest
along the more proximal aspect of the distal radius where it will heal and its
function can continue.
After this release of the brachioradialis, the freeze-dried iliac crest
allograft was contoured and impacted into place to achieve a bone bridge for
the lengthening.
Next, autograft was harvested from the dorsal aspect of the distal radius and
from the radial aspect of the distal radius. This autograft was then impacted
into the radial and ulnar aspects of the distal radius to allow for some
autograft bridging across the lengthened distal radius site.
Next, internal fixation was used to secure the osteoplasty. Two plates were
used from Synthes. These were 2.0 mm variable angle locking plates from the
varible angle locking handset. A combination of locking and nonlocking
screws were used for the fixation. The wound was copiously irrigated with
normal saline solution, taking care to protect the autografting. One screw
was also placed into the allograft in order to secure the allograft as well.
Next, the tourniquet was released. Careful hemostasis was obtained with Bovie
electrocautery. The retinaculum was repaired between the second and fourth
dorsal compartments, leaving the EPL in a subcutaneously transplanted
position. The subcutaneous layer was loosely reapproximated with interrupted
3-0 Vicryl suture. The skin and subcuticular layers were reapproximated with
a combination of interrupted 4-0 Prolene suture and 5-0 fast absorb plain gut
suture. Sterile dressings were then applied, followed by a well-padded sugar-
tong splint maintaining the forearm in neutral to slight supination. The DRUJ
was examined at the conclusion of the procedure and found to be stable. There
was a significant improvement in DRUJ stability after this closed reduction of
the DRUJ with the distal radius lengthening.
I need help with the procedures. I'm split between 25405 and 25391 and also is lengthening of brachioradialis inclusive or coded separately. Kindly advise. Thank you.
My final codes are 25310 and 25405 or 25391.
POSTOPERATIVE DIAGNOSES:
1. Left distal radius fracture shortening malunion.
2. Left brachioradialis tendon acute shortening contracture.
OPERATIONS PERFORMED:
1. Subcutaneous transplantation of the EPL, left wrist. (CPT:25310)
2. Lengthening of radius with autograft and allograft, left distal radius.(25405 or 25391)?
3. Lengthening tenotomy of the brachioradialis, left distal radius.
The procedure was begun with a dorsal approach to the left distal radius
centered over Lister's tubercle. Careful dissection was carried down to the
distal radius itself. Care was taken to identify and protect branches of the
radial sensory nerve.
Next, a subcutaneous transplantation of the EPL was performed. The EPL was
released from the third dorsal compartment. It was then transposed radially
to a subcutaneous position. Care was taken to ensure the tendon was not
constricting the fascia both proximally and distally.
Next, a dorsal approach to the distal radius was performed by elevating the
second dorsal compartment off the distal radius radially and then elevating
the fourth dorsal compartment off the distal radius ulnarly.
Next, the distal radius malunion site was marked with a 1.6 mm K-wire.
Fluoroscopic imaging was used to confirm the location not only of the
fracture, but of the planned osteotomy for lengthening. Next, multiple K-
wires were placed from dorsal to volar across the distal radius to facilitate
osteoclasis. Next, an osteotome was used to create the osteotomy at the
distal radius. Next, the distal radius was lengthened approximately 6 mm
ulnarly and approximately 8 to 9 mm radially. A freeze-dried cancellous
allograft bone graft was contoured and impacted into position for this
lengthening.
Prior to the lengthening, the brachioradialis was assessed. I was not able to
lengthen the radius adequately radially with the brachioradialis acute
shortening contracture present. As a result, a lengthening tenotomy of the
brachioradialis was performed. The tendon was released and allowed to rest
along the more proximal aspect of the distal radius where it will heal and its
function can continue.
After this release of the brachioradialis, the freeze-dried iliac crest
allograft was contoured and impacted into place to achieve a bone bridge for
the lengthening.
Next, autograft was harvested from the dorsal aspect of the distal radius and
from the radial aspect of the distal radius. This autograft was then impacted
into the radial and ulnar aspects of the distal radius to allow for some
autograft bridging across the lengthened distal radius site.
Next, internal fixation was used to secure the osteoplasty. Two plates were
used from Synthes. These were 2.0 mm variable angle locking plates from the
varible angle locking handset. A combination of locking and nonlocking
screws were used for the fixation. The wound was copiously irrigated with
normal saline solution, taking care to protect the autografting. One screw
was also placed into the allograft in order to secure the allograft as well.
Next, the tourniquet was released. Careful hemostasis was obtained with Bovie
electrocautery. The retinaculum was repaired between the second and fourth
dorsal compartments, leaving the EPL in a subcutaneously transplanted
position. The subcutaneous layer was loosely reapproximated with interrupted
3-0 Vicryl suture. The skin and subcuticular layers were reapproximated with
a combination of interrupted 4-0 Prolene suture and 5-0 fast absorb plain gut
suture. Sterile dressings were then applied, followed by a well-padded sugar-
tong splint maintaining the forearm in neutral to slight supination. The DRUJ
was examined at the conclusion of the procedure and found to be stable. There
was a significant improvement in DRUJ stability after this closed reduction of
the DRUJ with the distal radius lengthening.