Not sure which code to use CPT 25360 or 25390 any help would be appreciated.
The subcutaneous border of the ulna was identified and periosteum stripped palmarly. The Rayhack ulnar shortening osteotomy system was used. The guide was placed on the volar surface of the ulna and secured by sequentially placing screws #2, #4, and #3. The saw was used with copious irrigation to make a 3.5-mm shortening, using the 2 proximal slots, which were closest together. The saw guide was then removed. The plate was slightly contoured and secured with a screw in the #2 position. The compression guide was then applied using #3 and #4 screws, both about 4 mm longer than originally measured. The osteotomy was gently closed. The oblique cutting guide was placed and a 2.7-mm hole drilled through the near cortex. The top hat was placed and a 2 mm hole drill to the far cortex of the ulna. The length was measured, the hole was tapped and a 2.7 mm lag screw placed. The #5 screw was then placed followed by locking screws at either end of the plate. The compression guide was removed in the appropriate length 3 and 4 screws were then replaced. The image intensifier was brought into the field to verify the length of the screws, which were appropriately adjusted. The osteotomy was barely visible on the image intensifier and was very well approximated when visualized. The wounds were copiously irrigated. A tip of the bone taken from around the drill holes, was packed around the osteotomy site. The fascia was closed with running 4-0 PDS, subcutaneous tissue was closed with PDS, and the skin with a running subcuticular Monocryl suture. Sterile dressings and a short-arm splint were applied.
The subcutaneous border of the ulna was identified and periosteum stripped palmarly. The Rayhack ulnar shortening osteotomy system was used. The guide was placed on the volar surface of the ulna and secured by sequentially placing screws #2, #4, and #3. The saw was used with copious irrigation to make a 3.5-mm shortening, using the 2 proximal slots, which were closest together. The saw guide was then removed. The plate was slightly contoured and secured with a screw in the #2 position. The compression guide was then applied using #3 and #4 screws, both about 4 mm longer than originally measured. The osteotomy was gently closed. The oblique cutting guide was placed and a 2.7-mm hole drilled through the near cortex. The top hat was placed and a 2 mm hole drill to the far cortex of the ulna. The length was measured, the hole was tapped and a 2.7 mm lag screw placed. The #5 screw was then placed followed by locking screws at either end of the plate. The compression guide was removed in the appropriate length 3 and 4 screws were then replaced. The image intensifier was brought into the field to verify the length of the screws, which were appropriately adjusted. The osteotomy was barely visible on the image intensifier and was very well approximated when visualized. The wounds were copiously irrigated. A tip of the bone taken from around the drill holes, was packed around the osteotomy site. The fascia was closed with running 4-0 PDS, subcutaneous tissue was closed with PDS, and the skin with a running subcuticular Monocryl suture. Sterile dressings and a short-arm splint were applied.