such78
Expert
Post op dx: left hand scar contracture
Procedure: excision of left hand scar with fasciectomy and fasciotomies and multiple Z-plasties to reconstruct and close the resulting wound, injection of Kenalog into the soft tissues surrounding the wound closure?
Finding during this procedure: patient has a thick, hypertrophic scar as well as fibrosis of the underlying fascia in the palm of the left hand. This scar contracture tethers patient's thumb, index, middle, and ring finger and keeps him from opening his left hand for daily function and performing daily tasks. The scar is thick and hypertrophic, and the underlying fascia is thick and fibrotic and adherent to the flexor tendons.
a #15 blade scalpel was used to sharply excise the thick, hypertrophic scar in the palm of left hand. This excision was performed based on preoperative markings. Once the scar was excised, it was found that underneath the scar the fascia in the palm of the left hand in the subcutaneous tissue was also thick and fibrotic. This was excised as well. It was adherent to the underlying flexor tendons which were released from the fibrotic scar. After excising the fascia and performing fasciotomies left to release any additional points of tethering. I designed multiple Z- plasties around the excised tissue to lengthen and reduce the tension and stress in the left palm to allow for flexion and extension of his fingers. Based on intraoperative markings, multiple Z-plasties were performed to close the resulting scar excisional defect. This is then closed using 3-0 Nylon vertical mattress sutures. With combination of multiple Z-plasties and vertical mattress nylon suture closures, I was able to closed the resulting wound defect which measured approximately left 3.5 x 1.5 cm in size.
Is that correct to sign 26121 only, or do I also need to code palm scar excision?
Please advice. Thank you.
Procedure: excision of left hand scar with fasciectomy and fasciotomies and multiple Z-plasties to reconstruct and close the resulting wound, injection of Kenalog into the soft tissues surrounding the wound closure?
Finding during this procedure: patient has a thick, hypertrophic scar as well as fibrosis of the underlying fascia in the palm of the left hand. This scar contracture tethers patient's thumb, index, middle, and ring finger and keeps him from opening his left hand for daily function and performing daily tasks. The scar is thick and hypertrophic, and the underlying fascia is thick and fibrotic and adherent to the flexor tendons.
a #15 blade scalpel was used to sharply excise the thick, hypertrophic scar in the palm of left hand. This excision was performed based on preoperative markings. Once the scar was excised, it was found that underneath the scar the fascia in the palm of the left hand in the subcutaneous tissue was also thick and fibrotic. This was excised as well. It was adherent to the underlying flexor tendons which were released from the fibrotic scar. After excising the fascia and performing fasciotomies left to release any additional points of tethering. I designed multiple Z- plasties around the excised tissue to lengthen and reduce the tension and stress in the left palm to allow for flexion and extension of his fingers. Based on intraoperative markings, multiple Z-plasties were performed to close the resulting scar excisional defect. This is then closed using 3-0 Nylon vertical mattress sutures. With combination of multiple Z-plasties and vertical mattress nylon suture closures, I was able to closed the resulting wound defect which measured approximately left 3.5 x 1.5 cm in size.
Is that correct to sign 26121 only, or do I also need to code palm scar excision?
Please advice. Thank you.