How would this be coded? the path report stated "rheumatoid nodule"
PREOPERATIVE DIAGNOSIS: Rheumatoid nodules right thumb, index and long
finger and left long finger.
1. Removal of masses (rheumatoid nodules from the right index finger, right
long finger and right thumb).
2. Removal of rheumatoid nodule from the left long finger.
ANESTHESIA: Local with sedation.
INDICATIONS FOR PROCEDURE: 63-year-old male with tender nodules on the
working surfaces of the above mentioned fingers.
DESCRIPTION OF PROCEDURE: This 63-year-old male was brought to the
operating room where he was placed supine on the operating room table and
had induction of intravenous sedation. A pneumatic tourniquet was affixed
to the proximal aspect of the right upper extremity and the left forearm.
Both hands were then prepped and draped in the usual sterile fashion.
Right upper extremity was elevated and exsanguinated, and the tourniquet
was inflated to 250 mmHg. An incision was made over the nodules of the
index finger which were on the dorsal radial aspect. Two well encapsulated
nodules were identified that originated beneath the fascial surface and
were connected to the PIP joint. The dorsal cutaneous nerve was wrapped
around the nodules and dissected off the nodules and the nodules were
excised and submitted for pathologic examination.
A second incision was made over the nodule of the middle finger and
similarly this was dissected off surrounding deep tissues and submitted for
pathologic examination and had the gross appearance of a rheumatoid nodule.
All surgery was performed under loop magnification and cutaneous nerves
were preserved for a possible, and the digital nerve and artery were
identified and protected.
Third incision was made over the mass at the thumb and similarly it was
dissected off the flexor tendon sheath and submitted for pathologic
examination. Tourniquet was deflated at the right upper extremity. There
was no excessive bleeding. Wounds were irrigated and hemostasis was
obtained via gentle pressure and electrocautery. Marcaine with epinephrine
was used just at the skin edges, and plain Marcaine was used in the deep
tissues. Wounds were closed using nylon suture.
Attention was then paid to the left hand which had been prepped and draped.
Left arm tourniquet was inflated. Incision was made over the mass at the
left long finger and dissection was performed under magnification and the
nodule was dissected off nerves and tendon structures and submitted for
pathologic examination. Left hand tourniquet was deflated. Wound was
irrigated. There was no excessive bleeding. Hemostasis was obtained via
gentle pressure and electrocautery, and skin was closed with nylon. Bulky
dressing was applied to both hands. The patient tolerated the procedure
well and was transferred from the operating room to recovery room in stable