Patient was attacked by a cat and sustained a puncture wound of right wrist and multiple scratches. She was treated and given course of antibiotics but conditions worsened and she was admitted and given intravenous antibiotics. After multiple days int he hospital she still had swelling in her hand and an MRI showed evidence of tenosynovitis. She also exhibited significant pain over the puncture wound site. Op notes: A laterally based flap was drawn on the hand to include and expose the puncture site and the course of the extensor tendons to the middle and ring fingers over the dorsum of the hand. The flap was incised and raised. Dissection was carried down over the tendon sheath to expose the distal tendon. There was no purulence noted. Cultures were taken. Dissection was then continued into the proximal area and completely exposed the site of the puncture wound. A small collection of clear fluid was found under the fascia. This was cultured for both aerobic and anaerobic organisms. Then, the tendon sheath and the puncture would were irrigated copiously with a solution of bacitracin, polymyxin and saline. Hemostasis using the bipolar electrocautery was performed, wound was irrigated with anitbiotic solution and skin was closed with interrupted 4-0 nylon.

thank you for any and all suggestions. We tried unlisted procedure code 26989 but Medicare denied and the decision is not able to be appealed. We must correct and resubmit.