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Many of the changes are effective prior to the 2024 publication date. The American Medical Association (AMA) has posted its CPT® early release documentation for Category I immunization codes, Category III codes, and proprietary laboratory analyses (PLA) codes. These code changes will be included in the CPT® 2024 code set, but have various effective dates. […]
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Over the past several months, as the COVID-19 pandemic has raged on, the American Medical Association (AMA) has expedited the approval and release of CPT® codes to enable reporting of the various testing methodologies that have become available. The CPT® Editorial Panel convened a special meeting to approve additional codes specific to laboratory testing for […]
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#1 – 26160, 26055-59?
#2 – 26123?
The tourniquet was inflated to 200 mmHg and a 2cm bruner incision over the A1 pulley of the left ring finger and proximally over the dupuytrens disease. Starting proximally we identified the dupuytrens cord and then sharply dissected it from the skin creating full thickness flaps. The neurovascular bundles were identified and we then proceeded distally protecting the digital nerves and vessels. Once the dupuytrens was fully excised we went ahead and bluntly dissected down to the A1 pulley and then Ragnell retractors utilized to protect the digital nerves on either side. The A1 pulley was visualized, a hemostat placed under the A1 pulley and withdrawn until a click was appreciated between the A1 and A1 pulleys and then the A1 pulley was incised sharply with a scalpel. A ragnell retractor was used to gently pull and separate any scarring between the profundus and superficialis tendons. Any additional fibers were freed up distally and proximally using blunt dissection freeing up any proximal tethering fibers and the patient was asked to make a fist to make sure there was no triggering.
Thanks in advance.
Can these codes be billed together for the same finger? The diagnoses are: Right small finger Dupuytren’s contracture and right small finger PIP joint contracture with A1 trigger.
Thank you
Can these codes be billed on the same finger? The diagnoses are: Right thumb trigger thumb and right thumb flexor synovitis.
Thank you.
PREOPERATIVE DIAGNOSIS: Right hand compartment syndrome.
POSTOPERATIVE DIAGNOSIS: Right hand compartment syndrome.
PROCEDURE PERFORMED: Right carpal tunnel release and 10 compartment fasciotomy of the hand.
TYPE OF ANESTHESIA: General.
ESTIMATED BLOOD LOSS: There was minimal blood loss.
COMPLICATIONS: No complications.
TOTAL OPERATIVE TIME: 30 minutes.
INDICATIONS FOR PROCEDURE: The patient is a 51-year-old woman who was assaulted in her home. She I think lost consciousness, I am not entirely sure of the situation, but she is actually deaf on admission from head injury. She has pretty banged up and her right hand is intensely swollen. The immediate thought process is that when she lost consciousness, her hand was severely bent underneath her and lost vascularity for a pretty time and then when she woke up, the hand regained vascularity and this is a revascularization phenomenon with intense swelling. She clinically cannot moving her fingers. Her hand is ballooned out intensely, it is almost rock-hard and is correctly assessed emergently in the emergency room that this was a compartment syndrome. She was emergently brought up. I was called in as the attending and assessed her and I do believe this is a compartment syndrome. So therefore on a clinical basis, we are taking her to the operating room for a compartment least
and carpal tunnel release. Her sister is there as next of kin for consent as she is head injured and not doing very well and signed the consent for her. I would like to add that she has quite severe rhabdomyolysis and her kidneys are being affected. Therefore, she is in the intensive care unit for hydration and management of that as well.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room, placed in supine position. General anesthesia was induced by the anesthesiologist. The right upper extremity was prepped and draped in usual sterile fashion with the proximal arm tourniquet in place. After elevation for 15 seconds, the tourniquet was put up to 250 mmHg. A 2 cm incision was made to the base of palm aligned with radial aspect of the ring finger and the ulnar aspect of the palmaris longus tendon. It was taken down to the superficial tissues down to level of transverse carpal ligament. The transverse carpal ligament was incised perpendicular to its fibers distally until palmar fat was seen and an adequate decompression was verified. Under direct vision, the thickest portion of fibers of the ligament were incised and then the last centimeter of the distal forearm fascia was incised through until there not being any palpable compression. Once that was done, I moved on to the other
compartments of the hand. We made an incision over the thenar eminence and this muscle was white. It looked like the color of a chicken breast. It had no real color to it and no rebound blood flow. I went over the hypothenar eminence and made an incision over there and that had the same white appearance to the fibers. Over the first dorsal interosseous space, made an incision there and that tissue also had that dysvascular appearance. We then made incisions over the dorsal interspaces and this tissue looked a little better. The muscle looked a little bit more pink and that was between 2 and 3; 3 and 4; and 4 and 5. Once that was all done, the tourniquet was let down and I sat and watched the compartments for a while and over about 10-15 minutes, we did slowly get some bleeding from the edges. As the pressure was relieved, we manipulated the fingers to get the pressure down even more by getting rid of swelling. There was intense swelling around the dorsal aspect of the
hand and we released that just with massage through the wounds. The only wound that I closed was a carpal tunnel wound and the rest I covered with Xeroform. I worked diligently to get this into an intrinsic plus position, getting the MP joints down to 90 degrees, the PIP joints perfectly straight, DIP joints perfectly straight, wrist at 20 degrees and the thumb with a good first webspace distance. This was done with multiple burn dressings and wraps, all for edema and hand position. A splint was provided to keep her in this position. She tolerated everything well. She was awoken from general anesthesia and transferred to the intensive care unit.
procedures:
abductor hallucis fascia release
TT release
Plantar fascia release
Why would the halluces fascia be released?
I have been researching this topic, however most of the information I have found (even in these forums) are a few years old and/or have information backwards. Plus I am wanting to get a general idea what everyone is doing now, in 2018.
I am aware that 64721 bundles into 25115 when both carpal tunnel release is performed and a flexor tenosynovectomy is performed in the wrist at the same surgical session. The schools of thought I am seeing are:
It bundles, only code 25115
Code the original reason the procedure was performed (came in for ctr and they also performed a tenosynovectomy, bill for ctr release)
If there were/are separate diagnosis for each disorder, you can bill the 64721 with a 59.
I do not have a note to share, I am just trying to get the "pulse" as it were, of the protocols/directives and gather information all you wonderful coders may have.
Thank you!