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31627 has to be billed in conjunction with one from the series of codes listed in CPT pg187, but my physician did not perform any of those procedures instead he used the 31653 biopsies with EBUS. Has anyone one had this issue come up? Any suggestions?
Thank you,
Anna
Pt has ECU subluxation
The surgeon makes an incision down to the 6th dorsal compartment and dictates that it is slightly loose. THe ECU would mobilize in this, however, the ECU was not torn out of the sheath itself. This was then elevated subperiosteally from the ulnar side in order to keep the ECU within its subsheath. The tendon through the subsheath did not show any obvious tearing. At this point, with superiosteal dissection this allowed the facilitation of the ulnar groove, this was flattened slightly. A bur was used in order to deepen this to about 2mm. At which point placing a Freer in here I was able to appreciate a healthy concavity that would hold the ECU. The ECU was placed into the groove that was graded and held with a pickup and then bringing the wrist through ROM, pronation, supination multiple times there was no sublutation what was appreciated.
A mini Mitek anchor was place dont he ulnar border where the initial inciions had been made on the ECU sheath and then a second suture anchor just proximally. Both anchors were firm and stable. Then a mattress suture was placed in the subsheath as well incorporaing the extensor retinaculum of the 6th compartment and this located the ECU within the groove. This second anchor also had a mattress suture placed again incorporating both layers. These sutures were then placed in a running fashion proximally and distally to both acnchors creating a stable sheath.
The closest procedure I see is 25275 (no graft involved) possibly a comparable to unlisted.
Thank you in advance
The DX is Pterygium
I coded 65780 and
V2790
The excision of the pterygium without out graft(65420) is inclusive to 65780
Here’s the note:
After patient was identified and adequate peribulbar block, the patient was prepped and draped in sterile fashion. Correct surgical site was verified. Lid speculum is placed. This was followed by topical application of several drops of 1:1000 epinephrine to constrict blood vessels for subsequent hemostasis. Then 2% lidocaine gel was applied for topical anesthesia. Traction sutures are placed with 7-0 Vicryl at 6:00 and 12:00 o’clock. The eye is reflected temporally. This exposes the area of the pterygium plus excessive ocular scarring toward the medial canthus. Undr the microscope, the pterygium and the semilunar fold were identified. Using 0.12 forceps to pick up the semilunar fold, a peritomy was made in front of the semilunar fold and carried superiorly and inferiorly to the fornix. With the use of blunt and sharp dissection, the pterygium and fibroid vascular bundle is cleaned from the limbus and followed back toward the plica. Bleeding is managed with compression and wet field cautery. We then proceed to the head off the pterygium which is removed with combination of blunt and sharp dissection. Significant fibrous ocular tissue was dissected. Cornea surface smoothed using bur brush. Sealed gap with cautery. Layers of the amniotic membrane are required to reconstruct the ocular surface. This is done by cutting appropriate size strips of amniotic membrane, which are then glued with tissue glue in the appropriate areas. They are smoothed and found to be secure. We then approach the medial fibro vascular bundle. The amniotic membrane is then secured and smoothed out. It is tucked behind the free edges of conjunctiva. We then proceed to the corneal side to the dissection, where the amniotic membrane is additionally spread and glued to patch the corneal surface. Additional tissue glue is placed in the interface between the amniotic membrane and conjunctiva to further secure the amniotic membrane. A contact bandage was placed over the cornea. Patient tolerated the operation well. Thanks again
29888 and can I bill for the MCL repair 29999 or it’s included with the ACL repair. Thanks