Preop DX: Trapeziometacarpal arthritis, left
Procedure:
Carpal Trapeziectomy
Fasciocutaneous rotation flap
Beak ligament reconstruction
First to second tenodesis
Use of C-Arm fluoroscopic control.
An incision was made over the carpal trapezium and carried down through skin and subcutaneous tissues. Retractors were placed within the confines of the wound.
The carpal trapezium was then isolated. With used of an osteotome, the carpal trapezium was hemisected, and in a piecemeal fashion with a rongeur the carpal trap was fully resected.
Once the trap was resected, as confirmation by fluoroscopic guidance, a fasciocutaneous flap was elevated from the dorsum of the wrist. The fascial flap was then retracted.
A Kirshner wire was traversed from the base of the first metacarpal into the base of the second metacarpal, this reconstituting the beak ligament by stabilizing it with a trans versing K-wire. This was then followed with a Tightrope of durable stitching traversed from the base of the first to the base of the second and passed. The two sterile clips were then placed, one over the base of the first and one over the base of the second. These were then secured, allowing for the first to second tenodesis affect.
The facial flap was then placed and rotated into the soft tissue cavity remaining as a reconstruction as well as securing interspace tissues for correcting bone to bone apposition.
*** Depending on RT or LT, we code the surgery this way:
Z42.8
15736
M19.031
25320 – RT
M67.931
25300 – 59, RT
We are being denied for the Z42.8. Can someone tell me a more appropriate code to bill with?