Kathy Posted Mon 09th of March, 2015 13:09:19 PM
Please review the following note & advise if codes 26502-59, 64831, 26350 & 26180-59 would all be appropriate to report: Pt sustained a laceration to his left index finger on broken porcelain 2 wks previous. "I excised the previous volar transverse laceration centered over the PIP joint given the amount of maceration. I then tied this off along the radial mid lateral line again centered at the PIP crease. The 2 trangular flaps were then elevated across the mid axial line of the digit. There was a fair amount of scar tissue, We had to spend some time ID'ing the radial neurovascular bundle. The radial artery was lacerated & thrombosed. The proximal & distal stumps of the nerve were also ID'd. There was a rent in the A3 pulley right at its interface w/ the A4 pulley. Through this we were able to clearly see a lge laceration throught FCP tendon in zone 2. Similarly, the FDS tendon was transected along the radial border. I opted to not repair this given that the ulnar slip of the FDS was intact. In order to gain access to the distal FDP tendon I had to vent the pulley since we were at a level where I could not create a separate fenestration. We then performed dorsal epitendinous suture of 6-0 Prolene, followed by a 4-core cruciate repair w/4-0 fiber wire. I then continued the epitendinous suture in a running fashin over to the volar side of the tendon. There was a nice smooth tenorrhaphy. However, given the increase in the diameter after the repair I was unable to primary repair the pulley. Therefore I used the tendon from the FCP resection to create an intercalary reconstruction using figur-of-eight PDS sutures. Passive extension of the FDP tendon demontrated no gapping of the tendon reconstruction. The operating microscope was then brought to the field & we were able to primarily repair the radial digital nerve using interrupted 8-0 nylon sutures w/the digit held in extension. There was no tension on the repair. The repair was performed after the proxiaml & distal stumps of the nerve were transected to healthy appearing fascicles. We closed the incision in a single layer using 5-0 interrupted & horizontal mattress nylon sutures.
SuperCoder Answered Tue 10th of March, 2015 09:16:29 AM
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