Hello, I am inquiring about a bundling scenario my Physician and I are having some differences on and I wanted to get an opinion from you on it. We have cases where the trigger finger will be released at the level of the A1 pulley and the surgeon will lift the edge of the would and take some dissection towards the a-2 pulley and then excise said cyst from the A2 pulley. Our surgeon is wanting this unbundled for being separate issues and I am looking at it being done from the same incision seeing problems with Insurance. I will leave the documentation so nothing is left out for decision factor. Thank you in advance for your help.

After incision at distal palm overlying A1 pulley, veins protected, etc.:

".... The A1 pulley was incised longitudinally out to the proximal A2 pulley. proximally the fascial pulley was similarly divided. tendons were inspected, synovitis noted on the flexor tendons which was identified and debrided. Fraying tendon not present. There was no recurrent triggering with active flexion. In the area where the patient noted a mass was explored. This was along the proximal digital crease. By elevating the dorsal edge of the wound, dissection was taken out and a small retinacular cyst was noted to be coming off the A2 pulley. This was sharply excised...." They go on the close the incision