adunlap23
Guru
Patient presents with Left wrist EDC and EIP tendon rupture.
The op note details the following procedures:
Left wrist extensor tendon grafting, EDC tendon-digits 2-8
Left wrist EIP tendon graft
1. "...I opened the fourth extensor compartment. All four of the EDC tendons were ruptured and I identified the stump distally, which was about the level of the radiocarpal joint. I likewise identified the stump proximally. The rupture appeared to be over the DRUJ...
Attention was focused on tendon transfer. I took out the EIP tendon distally and used this as a tendon graft as there was segmental loss of the EDC tendon. I sutured both EDC tendon ends together to show them as a unit. Then I did at least three Pulvertaft weaves and multiple stitches of Ethibond performing tendon grafting using the previously identified EIP tendon stump as tendon graft. This resulted in excellent tendon graft and this was sewn in the appropriate tension. Pulling on this did result in good extension of the third through fifth digit."
He calls it a graft and a transfer, but it sounds more like tendon repair with graft. Would 26412 be appropriate?
2. "The patient had a separate and distinct EDC tendon, which I elected to separately graft as well. I used the remaining EDM tendon, which was clinically ruptured. I took this out with a small incision over the fifth metacarpal head. I then sutured this in an end-to-end fashion with multiple stitches of 3-0 Ethibond with figure-of-eight and Kessler stitches. This showed in the appropriate tension and did result in good extensor cascade of the EDC tendon."
I'm reading it as he sutured the end of the EDM tendon to the end of the EDC tendon. And the incision was over the metacarpals, so would 26480 be appropriate in this case?
The op note details the following procedures:
Left wrist extensor tendon grafting, EDC tendon-digits 2-8
Left wrist EIP tendon graft
1. "...I opened the fourth extensor compartment. All four of the EDC tendons were ruptured and I identified the stump distally, which was about the level of the radiocarpal joint. I likewise identified the stump proximally. The rupture appeared to be over the DRUJ...
Attention was focused on tendon transfer. I took out the EIP tendon distally and used this as a tendon graft as there was segmental loss of the EDC tendon. I sutured both EDC tendon ends together to show them as a unit. Then I did at least three Pulvertaft weaves and multiple stitches of Ethibond performing tendon grafting using the previously identified EIP tendon stump as tendon graft. This resulted in excellent tendon graft and this was sewn in the appropriate tension. Pulling on this did result in good extension of the third through fifth digit."
He calls it a graft and a transfer, but it sounds more like tendon repair with graft. Would 26412 be appropriate?
2. "The patient had a separate and distinct EDC tendon, which I elected to separately graft as well. I used the remaining EDM tendon, which was clinically ruptured. I took this out with a small incision over the fifth metacarpal head. I then sutured this in an end-to-end fashion with multiple stitches of 3-0 Ethibond with figure-of-eight and Kessler stitches. This showed in the appropriate tension and did result in good extensor cascade of the EDC tendon."
I'm reading it as he sutured the end of the EDM tendon to the end of the EDC tendon. And the incision was over the metacarpals, so would 26480 be appropriate in this case?
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