Wiki Tendon/Subcutaneous Debridement

[nolanspade]

Hello, working on this question for one of my doctors. He gave me the blurb that I'll put in quotes, but told me that he 9 extensor tendons required debridement.

Fifteen blade was used incise the skin along the dorsal aspect of the left hand and wrist. Subcutaneous dissection was performed with tenotomies. Copious amounts of purulence were able to be decompressed after dissection through the subcutaneous tissues. Two culture swabs were obtained. Further dissection was performed. There was a well-organized and multi loculated abscess along the dorsal aspect of the left hand and wrist. Infectious rind had developed within the subcutaneous tissues. There was extensive tenosynovitis along the ECRL, ECRB, EPL, 4 EDC tendons, EIP, and EDM. Tenosynovitis was circumferential about the tendons. There was further infectious changes about the distal margin of the 4th dorsal compartment. Tenosynovectomy was performed with a combination of tenotomies and rongeur. Distal aspect of the 4th dorsal compartment was incised. Additional inflammatory changes were debrided and excised. There was infectious rind extending along the dorsal aspect of the metacarpals, interossei muscle and dorsal wrist capsule. Excisional debridement was performed with a rongeur. Additional points of infectious rind within the subcutaneous tissues were excised. The incision was then copiously irrigated.

I have a couple thoughts on codes, but I'm sold on any of them, honestly. So my complaints are that he doesn't specify hand or wrist, so we don't know 26460 or 25290; and he doesn't convince me that more than one 25118 could have occurred. And 11043 is NCCI column 2 against them all!

Here's some descriptors of those codes:
26460 Tenotomy, extensor, hand or finger, open, each tendon
25290 Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single, each tendon
25118 Synovectomy, extensor tendon sheath, wrist, single compartment (I don't think there is one for the hand, only for the fingers.)
11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less