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Thank you!
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
My provider is performing a ECU stabilization and distal ulna ostectomy craterization for painful subluxation. I’m thinking that CPT 25275 is the correct code for the ECU stabilization but I’m not sure what code to use for the ostectomy (or if this is even billable)?
Thanks in advance.
The extensor retinaculum identified over the distal ulna. This was incised volar and more ulnar and then flipped back. The subsheath of the ECU was identified. We then released the subsheath from the periosteum volarly and the ulna just volar to the ulnar groove. The ECU was taken with the subsheath and then retracted back radially, identifying the groove. The groove was quite shallow. We then used a bur to deepen the groove approximately 2 mm, making sure we smoothed out any edges. We then placed two 1 mm JuggerKnot suture anchors on the volar aspect of the groove. We then tied down the ECU subsheath, imbricating it ulnarly, so as to reduce of any redundancy. We then incorporated the extensor retinaculum repair in with the same sutures of the JuggerKnot, closing the extensor retinaculum nicely. Taking the wrist in pronation and supination, this held the ECU nicely in position in the groove and radial, as it should be. We then went ahead, thoroughly irrigated and closed skin using a 4-0 Vicryl followed by interrupted 4-0 Prolene. The arm was splinted in supination to protect the ECU subsheath repair.