luisa Posted Tue 09th of May, 2017 19:11:05 PM
My physician performed a first webspace release with division of fibrous bands, release of adductor policis & 1st dorsal interosseous muscle fascia.
2. Lt 1st dorsal metacarpal artery flap elevation & transposition.
3. Full thickness skin graft 2 cm2 from antecubital fossa.
He wants to bill 15740,14301,14041,15004,15220 & 15200.
SuperCoder Answered Wed 10th of May, 2017 07:08:47 AM
Could you please provide more details of the procedure performed? Additional information will help determining appropriate codes.
luisa Posted Thu 11th of May, 2017 09:22:47 AM
A longitudinal release was designed at the apex of the first webspace. A 1st dorsal metacarpal artery flap was designed w/ the base spanning the width btwn the base of the thumb metacarpal & the base of the long finger metacarpal. The extended to halfway up the dorsum of the proximal phalanx of the index finger.
The hand was inflated 250 mmHg. The skin was incised in the webspace. Dissection revealed dense fibrous bands btwn the metacarpal heads of the index & thumb metacarpals. These were divided. We encountered tight fibrous fascia of the adductor policis & dorsal interosseous which was taken down completely as well.
The unlar digital artery to the thumb from the superficial palmar arch was identified & was maintained, as it came across the 1st webspace from ulnarly. This was the limiting factor for achieving additional span of the 1st webspace.
The 1st dorsal metacarpal artery flap was elevated from distal to proximal, leaving extensor paratenon intact, & it was taken deep to all of the adipofascial vascularized tissue. Along the 1st dorsal interosseous muscle, we went deep to the muscle fascia & elevated it in conjunction w/ the flap in order to capture the axial vessels. We went all the way back until orgin of the 1st dorsal metacarpal vessels & left those intact.
luisa Posted Thu 11th of May, 2017 09:33:34 AM
Meticulous hemostasis was obtained. The wound was irrigated copiously w/ saline. Quarter percent Marcaine was placed in all the subcutaneous tissues. The flap was transposed & inset with serial advancement in order to take tension off the tip. The donor site was closed. There was a very small opening over the index metacarpal head with lining by vascularized paratenon, which was filled with a full thickness skin graft harvested in an ellipitical fashion from the antecubital fossa and inset under tension here. The donor site was closed with deep dermal 4-0 Monocryl followed by subuticular 4-0 Moonocryl and Dermabond. The tourniquet was taken down and there was noted to be capillary refill all the way to the tip of the flap.
All the hand closures and the insetting of the skin graft were done with 4-0 Vicryl Rapide. He was dressed with Xeroform, mineral oil and saline soaked cotton as a bolster for the skin graft, followed by 4x4 fluffs in the webspace holding him in maximum palmar abduction . he was dressed with Webril. The tourniquet was released and removed. He was placed into elbow flexion with the elbow at greater than 90 degrees flexion, and was placed into a 2-inch fiberglass cast in a clenched fist fashion.
SuperCoder Answered Fri 12th of May, 2017 03:04:10 AM
As per the medical documentation, appropriate CPT codes would be:
14040- 59, 14301, 15004, 15740, 15220