K8teg1987
Guest
I was hoping someone could assist me in coding this case, I am unable to find where debridement is for the fingers, thank you
Right index, middle, ring finger mucous cysts with distal interphalangeal joint arthritis.
Plan: We are going to debride the distal interphalangeal joint index, middle and ring fingers after informed consent and timeout. Local block was performed with 11 mL of 1% lidocaine plain with bicarbonate. Right hand was prepped and draped in sterile fashion. Timeout was performed. Hand was verified. With the right hand prepped and draped in sterile fashion, index finger was addressed first with a glove tourniquet applied. A triradiate incision was made over the dorsal aspect of the distal interphalangeal joint. The extensor tendon to the collateral ligament capsule was debrided between the extensor tendon and collateral ligament on the radial and ulnar sides. Significant osteophytes were present. These were debrided using a rongeur and a curette under the extensor tendon. Once this was smoothed off, the wound was irrigated copiously with saline. Tourniquet was removed. Skin was closed with 5-0 Prolene in an interrupted manner. Attention was then turned to the middle finger, where we placed a glove tourniquet, triradiate incision made. Again, the capsule was excised between the extensor tendon and collateral ligaments on the radial and ulnar sides. Each side was debrided using a rongeur and a curette under the extensor tendon until it was smooth with the mucous cyst removed and the dorsal joint debrided bone and soft tissue. The wound was irrigated with saline with the tourniquet removed and the skin was closed with 5-0 Prolene in an interrupted manner.
Ring finger was addressed next with the triradiate incision made after the glove tourniquet was applied. The capsule was debrided between the extensor tendon and collateral ligament on the ring finger distal interphalangeal joint using a rongeur and curette, and we curetted under the extensor tendon. With the mucous cyst and the dorsal joint surface debrided, the wound was irrigated with saline and the skin was closed with 5-0 Prolene in an interrupted manner. It was done after the tourniquet was removed.
The wounds were cleaned, covered with Xeroform, 4 x 4's, Kling, and tape. She had good capillary refill to the fingertips. She was discharged to followup in approximately 2 weeks for suture removal. The patient was given Norco 5 #20 one every 4 hours p.r.n. pain, no refills. First line of treatment will be Tylenol. Keep it elevated. She may change the dressing in 3 days if needed. She was told the possibility of recurrence and also could have a little numbness.
Right index, middle, ring finger mucous cysts with distal interphalangeal joint arthritis.
Plan: We are going to debride the distal interphalangeal joint index, middle and ring fingers after informed consent and timeout. Local block was performed with 11 mL of 1% lidocaine plain with bicarbonate. Right hand was prepped and draped in sterile fashion. Timeout was performed. Hand was verified. With the right hand prepped and draped in sterile fashion, index finger was addressed first with a glove tourniquet applied. A triradiate incision was made over the dorsal aspect of the distal interphalangeal joint. The extensor tendon to the collateral ligament capsule was debrided between the extensor tendon and collateral ligament on the radial and ulnar sides. Significant osteophytes were present. These were debrided using a rongeur and a curette under the extensor tendon. Once this was smoothed off, the wound was irrigated copiously with saline. Tourniquet was removed. Skin was closed with 5-0 Prolene in an interrupted manner. Attention was then turned to the middle finger, where we placed a glove tourniquet, triradiate incision made. Again, the capsule was excised between the extensor tendon and collateral ligaments on the radial and ulnar sides. Each side was debrided using a rongeur and a curette under the extensor tendon until it was smooth with the mucous cyst removed and the dorsal joint debrided bone and soft tissue. The wound was irrigated with saline with the tourniquet removed and the skin was closed with 5-0 Prolene in an interrupted manner.
Ring finger was addressed next with the triradiate incision made after the glove tourniquet was applied. The capsule was debrided between the extensor tendon and collateral ligament on the ring finger distal interphalangeal joint using a rongeur and curette, and we curetted under the extensor tendon. With the mucous cyst and the dorsal joint surface debrided, the wound was irrigated with saline and the skin was closed with 5-0 Prolene in an interrupted manner. It was done after the tourniquet was removed.
The wounds were cleaned, covered with Xeroform, 4 x 4's, Kling, and tape. She had good capillary refill to the fingertips. She was discharged to followup in approximately 2 weeks for suture removal. The patient was given Norco 5 #20 one every 4 hours p.r.n. pain, no refills. First line of treatment will be Tylenol. Keep it elevated. She may change the dressing in 3 days if needed. She was told the possibility of recurrence and also could have a little numbness.