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Resection of carpal trapezium w/internal brace stabilization for thumb base arthritis

Hi all,
I would like an expert opinion on which CPT code is most appropriate for what looks like a "suspension version" of a CMC arthroplasty.

Per op report:
"…A marked amount of arthritis at the trapezial
carpometacarpal joint was identified. The trapezium was
osteotomized in 3 places with an osteotome, and the bone was
removed in fragments completely. The wound was irrigated with
antibiotic solution. With a 1.5 mm double-stranded labral tape,
we placed the anchor into the articular base of the second
metacarpal, strung it across the base of the metacarpal, and
then placed a second anchor very snugly with the double
stranded 1.5 mm labral tape into the lateral portion of the
metacarpal base. This suspended the metacarpal and stabilized
it completely, with good positioning and no evident subluxing.
We then irrigated again and placed some antibiotic-soaked
Gelfoam in the space of the trapezium, did a very tight
capsular repair with 3-0 Mersilene sutures, mattresses, and
then closed the skin subcuticular with Monocryl…"

Would this be a 25447 even though no tendon transfers are mentioned as performed?
If 25447 is the most appropriate code, should a -52 be appended?

Thanks,
Aubrey CPC, CRC, COC

Medical Billing and Coding Forum

Patella Knee Support – A New Medical Grade Knee Brace Can Help!

Does your kneecap ever bother you?

Hey, let’s face it, sometimes your kneecap (patella) can dislocate or just kind of have a raw, painful feeling. – Some options you can try at home are ice, rest, and a knee brace. Let’s talk a bit more on these subjects to help you get a good idea of what your options are…

1.) Rest & Ice

Sure, these remedies have helped people in the past and they help you too if you have some pain issues or swelling problems. The problem is that these remedies only go so far…

Rest that Knee! : Rest is great, when you are in the moment, but how many of us can really avoid moving around all the time. – Life just asks to much of us…

Ice : Ice definitely has its place. Its been around almost forever as a method of calming flare ups, and helping to control swelling issues you might have. We have all seen our sports heros use ice on their knees when they sit on the bench after a tough game. – However, the problem is that you can not run around with ice bags hooked up to your knees, so you will more than likely benefit from another idea besides just rest and ice…

2.) A Patella Knee Support

With all of the new innovations today, you can find a patella knee support that does not have to be really bulky, nor does it have to be all the big on your leg either.

A Dislocating Patella

Sometimes people have this problem because their patella (kneecap) just does not “track” correctly. See there is a groove in your femur where your patella is supposed to glide over, called the femoral groove. If the “tracking” of your patella is not adequate, you can dislocate your kneecap! Not only is that painful physically, but it must be painful mentally when you see your patella drifting toward the outside of your leg!
Certain knee braces can help control this kind of outward movement quite well!

A Painful Kneecap

There are a host of other reasons why your patella can bother you. Maybe you banged it, maybe you have another diagnosis that will explain where the pain is coming from…. Either way, a simple knee sleeve can be all it takes to help control the patella so it does not give you soo much pain! Knee sleeves are not for everyone, but they are known for helping to provide some extra support and that might be all you need. – Speak with your brace provider with any questions about braces, and make sure to clear medical advice with your physician prior to using it. This article is great medical information about knee braces, but you must not neglect seeing your doctor regularly.

The Knee Brace Shop

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