{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.769,"endTime":13.349,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.769,"endTime":13.349,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.349,"endTime":14.489,"body":"Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":14.72,"endTime":16.58,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.72,"endTime":16.58,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.58,"endTime":19.67,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.58,"endTime":19.67,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.67,"endTime":21.5,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.67,"endTime":21.5,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.07,"endTime":24.35,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.07,"endTime":24.35,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.35,"endTime":25.25,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.46,"endTime":27.68,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.46,"endTime":27.68,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.68,"endTime":28.22,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":29.57,"endTime":30.44,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":29.57,"endTime":30.44,"body":"Chris."},{"speaker":"Chris Dy","startTime":30.68,"endTime":31.64,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":30.68,"endTime":31.64,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":31.0,"endTime":33.67,"body":"I'm doing"},{"speaker":"Charles Goldfarb","startTime":31.0,"endTime":33.67,"body":"great. How are you this fine"},{"speaker":"Charles Goldfarb","startTime":33.67,"endTime":34.51,"body":"Sunday morning?"},{"speaker":"Chris Dy","startTime":34.78,"endTime":37.66,"body":"Oh, well, I'm inside"},{"speaker":"Chris Dy","startTime":34.78,"endTime":37.66,"body":"on a beautiful Sunday morning."},{"speaker":"Chris Dy","startTime":37.84,"endTime":42.19,"body":"But just finishing rounding. You"},{"speaker":"Chris Dy","startTime":37.84,"endTime":42.19,"body":"know, it's interesting, we have"},{"speaker":"Chris Dy","startTime":42.19,"endTime":45.7,"body":"this policy now, where, you"},{"speaker":"Chris Dy","startTime":42.19,"endTime":45.7,"body":"know, we have to, you know,"},{"speaker":"Chris Dy","startTime":46.03,"endTime":48.82,"body":"attending physician must see the"},{"speaker":"Chris Dy","startTime":46.03,"endTime":48.82,"body":"patients seven days out of the"},{"speaker":"Chris Dy","startTime":48.82,"endTime":53.41,"body":"week. And it's really nice to"},{"speaker":"Chris Dy","startTime":48.82,"endTime":53.41,"body":"actually sit, not sit, but"},{"speaker":"Chris Dy","startTime":53.41,"endTime":55.24,"body":"actually walk around with the"},{"speaker":"Chris Dy","startTime":53.41,"endTime":55.24,"body":"resident and talk to the"},{"speaker":"Chris Dy","startTime":55.24,"endTime":58.09,"body":"resident. I feel like that's"},{"speaker":"Chris Dy","startTime":55.24,"endTime":58.09,"body":"probably the biggest perk that"},{"speaker":"Chris Dy","startTime":58.09,"endTime":60.52,"body":"I've noticed, obviously, the"},{"speaker":"Chris Dy","startTime":58.09,"endTime":60.52,"body":"patient care part of it too. But"},{"speaker":"Chris Dy","startTime":60.94,"endTime":63.49,"body":"just a little downtime with with"},{"speaker":"Chris Dy","startTime":60.94,"endTime":63.49,"body":"the residents is kind of fun."},{"speaker":"Charles Goldfarb","startTime":63.94,"endTime":65.89,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":63.94,"endTime":65.89,"body":"think that resonates with me on"},{"speaker":"Charles Goldfarb","startTime":65.89,"endTime":69.37,"body":"two counts. One, I totally"},{"speaker":"Charles Goldfarb","startTime":65.89,"endTime":69.37,"body":"agree. I don't love going into"},{"speaker":"Charles Goldfarb","startTime":69.37,"endTime":71.44,"body":"round. That's why I went to an"},{"speaker":"Charles Goldfarb","startTime":69.37,"endTime":71.44,"body":"surgery. So I didn't have to do"},{"speaker":"Charles Goldfarb","startTime":71.44,"endTime":74.02,"body":"that much. One of the reasons I"},{"speaker":"Charles Goldfarb","startTime":71.44,"endTime":74.02,"body":"went to hand surgery, but"},{"speaker":"Charles Goldfarb","startTime":74.08,"endTime":76.9,"body":"hanging out with the residents"},{"speaker":"Charles Goldfarb","startTime":74.08,"endTime":76.9,"body":"and getting in rounding is okay,"},{"speaker":"Charles Goldfarb","startTime":76.9,"endTime":78.79,"body":"and honestly, I don't think"},{"speaker":"Charles Goldfarb","startTime":76.9,"endTime":78.79,"body":"we're adding much to patient"},{"speaker":"Charles Goldfarb","startTime":78.79,"endTime":84.7,"body":"care. But occasionally we might."},{"speaker":"Charles Goldfarb","startTime":78.79,"endTime":84.7,"body":"But the second resident point is"},{"speaker":"Charles Goldfarb","startTime":84.73,"endTime":89.14,"body":"you and I had been doing what we"},{"speaker":"Charles Goldfarb","startTime":84.73,"endTime":89.14,"body":"old school called the resident"},{"speaker":"Charles Goldfarb","startTime":89.14,"endTime":92.56,"body":"fellow clinic, and attending"},{"speaker":"Charles Goldfarb","startTime":89.14,"endTime":92.56,"body":"there. And I have to say that"},{"speaker":"Charles Goldfarb","startTime":92.56,"endTime":95.44,"body":"has been fantastic. I really"},{"speaker":"Charles Goldfarb","startTime":92.56,"endTime":95.44,"body":"enjoyed that. It's just a very"},{"speaker":"Charles Goldfarb","startTime":95.44,"endTime":98.47,"body":"different environment in the"},{"speaker":"Charles Goldfarb","startTime":95.44,"endTime":98.47,"body":"sense that the residents or"},{"speaker":"Charles Goldfarb","startTime":98.47,"endTime":100.69,"body":"fellows, quote, unquote, own the"},{"speaker":"Charles Goldfarb","startTime":98.47,"endTime":100.69,"body":"patients, I'm there for"},{"speaker":"Charles Goldfarb","startTime":100.69,"endTime":103.45,"body":"consultation, and I love that"},{"speaker":"Charles Goldfarb","startTime":100.69,"endTime":103.45,"body":"environment."},{"speaker":"Chris Dy","startTime":104.26,"endTime":106.45,"body":"You know, I enjoyed"},{"speaker":"Chris Dy","startTime":104.26,"endTime":106.45,"body":"the last time I was there,"},{"speaker":"Chris Dy","startTime":106.48,"endTime":112.06,"body":"mainly because I brought snacks"},{"speaker":"Chris Dy","startTime":106.48,"endTime":112.06,"body":"was great. I did that I remember"},{"speaker":"Chris Dy","startTime":112.06,"endTime":114.76,"body":"I did that clinic as a fellow"},{"speaker":"Chris Dy","startTime":112.06,"endTime":114.76,"body":"here. It is a very important"},{"speaker":"Chris Dy","startTime":114.76,"endTime":117.7,"body":"part of my experience and one"},{"speaker":"Chris Dy","startTime":114.76,"endTime":117.7,"body":"that I wouldn't trade for"},{"speaker":"Chris Dy","startTime":117.7,"endTime":120.73,"body":"anything. And I think having"},{"speaker":"Chris Dy","startTime":117.7,"endTime":120.73,"body":"some additional attending"},{"speaker":"Chris Dy","startTime":120.73,"endTime":123.94,"body":"involvement in whichever way is"},{"speaker":"Chris Dy","startTime":120.73,"endTime":123.94,"body":"useful to the trainees. You"},{"speaker":"Chris Dy","startTime":123.94,"endTime":126.16,"body":"know, the residents, fellows do"},{"speaker":"Chris Dy","startTime":123.94,"endTime":126.16,"body":"a fantastic job in that clinic."},{"speaker":"Chris Dy","startTime":126.16,"endTime":129.58,"body":"And they clearly show ownership"},{"speaker":"Chris Dy","startTime":126.16,"endTime":129.58,"body":"and they value that you don't"},{"speaker":"Chris Dy","startTime":129.58,"endTime":132.82,"body":"just be a small part of it"},{"speaker":"Chris Dy","startTime":129.58,"endTime":132.82,"body":"again, it's nice. Rounding this"},{"speaker":"Chris Dy","startTime":132.82,"endTime":134.95,"body":"morning, of course, all the"},{"speaker":"Chris Dy","startTime":132.82,"endTime":134.95,"body":"things that happened when he"},{"speaker":"Chris Dy","startTime":134.95,"endTime":138.7,"body":"round happened. So first patient"},{"speaker":"Chris Dy","startTime":134.95,"endTime":138.7,"body":"we went to see had just gotten"},{"speaker":"Chris Dy","startTime":138.7,"endTime":142.96,"body":"into the bathroom. Another"},{"speaker":"Chris Dy","startTime":138.7,"endTime":142.96,"body":"patient that we're gonna go see,"},{"speaker":"Chris Dy","startTime":143.41,"endTime":146.44,"body":"was literally getting"},{"speaker":"Chris Dy","startTime":143.41,"endTime":146.44,"body":"transported as soon as we got to"},{"speaker":"Chris Dy","startTime":146.44,"endTime":151.72,"body":"there. So I won't say it was the"},{"speaker":"Chris Dy","startTime":146.44,"endTime":151.72,"body":"most efficient rounds. And then"},{"speaker":"Chris Dy","startTime":151.72,"endTime":155.29,"body":"of course, somebody got added"},{"speaker":"Chris Dy","startTime":151.72,"endTime":155.29,"body":"onto our list to see right at"},{"speaker":"Chris Dy","startTime":155.29,"endTime":159.04,"body":"the end. So but it was fun. Joe"},{"speaker":"Chris Dy","startTime":155.29,"endTime":159.04,"body":"Vivian is actually I think on"},{"speaker":"Chris Dy","startTime":159.04,"endTime":162.49,"body":"your service right now and"},{"speaker":"Chris Dy","startTime":159.04,"endTime":162.49,"body":"fantastic resident a lot of fun"},{"speaker":"Chris Dy","startTime":162.49,"endTime":165.16,"body":"to work with. And yeah, that was"},{"speaker":"Chris Dy","startTime":162.49,"endTime":165.16,"body":"it's a nice thing."},{"speaker":"Charles Goldfarb","startTime":166.15,"endTime":169.78,"body":"Yeah, yeah,"},{"speaker":"Charles Goldfarb","startTime":166.15,"endTime":169.78,"body":"those are the frustrations of"},{"speaker":"Charles Goldfarb","startTime":169.78,"endTime":173.65,"body":"rounding. And when you're trying"},{"speaker":"Charles Goldfarb","startTime":169.78,"endTime":173.65,"body":"to, you know, take your time and"},{"speaker":"Charles Goldfarb","startTime":173.68,"endTime":177.55,"body":"be you know, teach and then you"},{"speaker":"Charles Goldfarb","startTime":173.68,"endTime":177.55,"body":"get stymied at every turn with a"},{"speaker":"Charles Goldfarb","startTime":177.79,"endTime":180.01,"body":"with a hiccup, it can get a"},{"speaker":"Charles Goldfarb","startTime":177.79,"endTime":180.01,"body":"little frustrating."},{"speaker":"Chris Dy","startTime":181.54,"endTime":182.8,"body":"What do you been up to"},{"speaker":"Chris Dy","startTime":181.54,"endTime":182.8,"body":"otherwise?"},{"speaker":"Charles Goldfarb","startTime":184.43,"endTime":185.99,"body":"You know, it's"},{"speaker":"Charles Goldfarb","startTime":184.43,"endTime":185.99,"body":"really this week has been"},{"speaker":"Charles Goldfarb","startTime":185.99,"endTime":190.22,"body":"reentry. I was fortunate enough"},{"speaker":"Charles Goldfarb","startTime":185.99,"endTime":190.22,"body":"to go away with the family on a"},{"speaker":"Charles Goldfarb","startTime":190.22,"endTime":194.12,"body":"wonderful vacation as I think"},{"speaker":"Charles Goldfarb","startTime":190.22,"endTime":194.12,"body":"you did as well and had a"},{"speaker":"Charles Goldfarb","startTime":194.12,"endTime":198.26,"body":"wonderful time and you know,"},{"speaker":"Charles Goldfarb","startTime":194.12,"endTime":198.26,"body":"come back and and just get back"},{"speaker":"Charles Goldfarb","startTime":198.26,"endTime":202.43,"body":"in the game. And it was a good"},{"speaker":"Charles Goldfarb","startTime":198.26,"endTime":202.43,"body":"week. Clinically, you know, very"},{"speaker":"Charles Goldfarb","startTime":202.43,"endTime":205.34,"body":"busy as you know, most of us are"},{"speaker":"Charles Goldfarb","startTime":202.43,"endTime":205.34,"body":"when we come back you get busy"},{"speaker":"Charles Goldfarb","startTime":205.34,"endTime":208.1,"body":"before you get busy after will"},{"speaker":"Charles Goldfarb","startTime":205.34,"endTime":208.1,"body":"take me a couple of weeks I"},{"speaker":"Charles Goldfarb","startTime":208.1,"endTime":213.14,"body":"think to catch up completely."},{"speaker":"Charles Goldfarb","startTime":208.1,"endTime":213.14,"body":"Yeah, how was your your first"},{"speaker":"Charles Goldfarb","startTime":213.14,"endTime":213.71,"body":"week back?"},{"speaker":"Chris Dy","startTime":214.4,"endTime":217.49,"body":"It was good. Pretty"},{"speaker":"Chris Dy","startTime":214.4,"endTime":217.49,"body":"much the same. was a little"},{"speaker":"Chris Dy","startTime":217.49,"endTime":219.98,"body":"surprised by how refreshed I"},{"speaker":"Chris Dy","startTime":217.49,"endTime":219.98,"body":"felt after traveling with"},{"speaker":"Chris Dy","startTime":219.98,"endTime":224.24,"body":"children, young children. It's a"},{"speaker":"Chris Dy","startTime":219.98,"endTime":224.24,"body":"bit of a hit or miss not exactly"},{"speaker":"Chris Dy","startTime":224.24,"endTime":227.45,"body":"vacation, but it was there was"},{"speaker":"Chris Dy","startTime":224.24,"endTime":227.45,"body":"some relaxation, and some"},{"speaker":"Chris Dy","startTime":227.45,"endTime":231.38,"body":"recharging. So I felt pretty"},{"speaker":"Chris Dy","startTime":227.45,"endTime":231.38,"body":"good coming back. So any"},{"speaker":"Chris Dy","startTime":231.38,"endTime":233.51,"body":"interesting emails that you've"},{"speaker":"Chris Dy","startTime":231.38,"endTime":233.51,"body":"received recently?"},{"speaker":"Charles Goldfarb","startTime":234.23,"endTime":236.87,"body":"Yes, I got."},{"speaker":"Charles Goldfarb","startTime":234.23,"endTime":236.87,"body":"I've gotten a couple of really"},{"speaker":"Charles Goldfarb","startTime":236.87,"endTime":240.02,"body":"interesting emails lately"},{"speaker":"Charles Goldfarb","startTime":236.87,"endTime":240.02,"body":"regarding the podcast. The first"},{"speaker":"Charles Goldfarb","startTime":240.02,"endTime":244.79,"body":"one is was from Andy Nelson, who"},{"speaker":"Charles Goldfarb","startTime":240.02,"endTime":244.79,"body":"is a hand society member, a"},{"speaker":"Charles Goldfarb","startTime":244.79,"endTime":249.71,"body":"listserv participant, and he"},{"speaker":"Charles Goldfarb","startTime":244.79,"endTime":249.71,"body":"wanted to follow up and discuss"},{"speaker":"Charles Goldfarb","startTime":249.86,"endTime":255.35,"body":"a little bit more about"},{"speaker":"Charles Goldfarb","startTime":249.86,"endTime":255.35,"body":"technique for arthroscopic TFCC"},{"speaker":"Charles Goldfarb","startTime":255.35,"endTime":259.31,"body":"repair, specifically foveal"},{"speaker":"Charles Goldfarb","startTime":255.35,"endTime":259.31,"body":"repair. And this was in response"},{"speaker":"Charles Goldfarb","startTime":259.31,"endTime":264.08,"body":"to our deep dive on surgical"},{"speaker":"Charles Goldfarb","startTime":259.31,"endTime":264.08,"body":"technique. And we had a good"},{"speaker":"Charles Goldfarb","startTime":264.11,"endTime":269.36,"body":"email conversation. And I have"},{"speaker":"Charles Goldfarb","startTime":264.11,"endTime":269.36,"body":"to say, you know, Andy is in, in"},{"speaker":"Charles Goldfarb","startTime":269.36,"endTime":273.32,"body":"New Britain, Connecticut. And"},{"speaker":"Charles Goldfarb","startTime":269.36,"endTime":273.32,"body":"while I've known him for a long"},{"speaker":"Charles Goldfarb","startTime":273.32,"endTime":276.68,"body":"time, I don't know him super"},{"speaker":"Charles Goldfarb","startTime":273.32,"endTime":276.68,"body":"well, but I was a happy he"},{"speaker":"Charles Goldfarb","startTime":276.68,"endTime":279.5,"body":"discovered the podcast and it's"},{"speaker":"Charles Goldfarb","startTime":276.68,"endTime":279.5,"body":"always, you know, it's just so"},{"speaker":"Charles Goldfarb","startTime":279.5,"endTime":286.82,"body":"interesting how this podcast is"},{"speaker":"Charles Goldfarb","startTime":279.5,"endTime":286.82,"body":"becoming more and more people"},{"speaker":"Charles Goldfarb","startTime":286.82,"endTime":289.13,"body":"are becoming more and more aware"},{"speaker":"Charles Goldfarb","startTime":286.82,"endTime":289.13,"body":"of it, but in very different"},{"speaker":"Charles Goldfarb","startTime":289.13,"endTime":291.74,"body":"time points. And second of all,"},{"speaker":"Charles Goldfarb","startTime":289.13,"endTime":291.74,"body":"that he became aware of it has a"},{"speaker":"Charles Goldfarb","startTime":291.74,"endTime":294.11,"body":"long commute. He's been enjoying"},{"speaker":"Charles Goldfarb","startTime":291.74,"endTime":294.11,"body":"listening to it and I love the"},{"speaker":"Charles Goldfarb","startTime":294.11,"endTime":295.85,"body":"fact that he followed up with"},{"speaker":"Charles Goldfarb","startTime":294.11,"endTime":295.85,"body":"questions."},{"speaker":"Chris Dy","startTime":296.96,"endTime":300.14,"body":"Questions are always"},{"speaker":"Chris Dy","startTime":296.96,"endTime":300.14,"body":"always welcome. So if anybody He"},{"speaker":"Chris Dy","startTime":300.14,"endTime":302.09,"body":"has any questions, feel free to"},{"speaker":"Chris Dy","startTime":300.14,"endTime":302.09,"body":"email them to"},{"speaker":"Chris Dy","startTime":302.09,"endTime":305.57,"body":"handpodcast@gmail.com or leave"},{"speaker":"Chris Dy","startTime":302.09,"endTime":305.57,"body":"them in a review. But yes, Andy,"},{"speaker":"Chris Dy","startTime":305.57,"endTime":307.85,"body":"thanks for listening. And thanks"},{"speaker":"Chris Dy","startTime":305.57,"endTime":307.85,"body":"for spreading the word on the"},{"speaker":"Chris Dy","startTime":307.85,"endTime":309.62,"body":"listserv. I know that we've"},{"speaker":"Chris Dy","startTime":307.85,"endTime":309.62,"body":"gotten a little buzz on there."},{"speaker":"Chris Dy","startTime":309.62,"endTime":314.24,"body":"And listserv is a fantastic"},{"speaker":"Chris Dy","startTime":309.62,"endTime":314.24,"body":"resource for many, many"},{"speaker":"Chris Dy","startTime":314.24,"endTime":317.0,"body":"practicing hand surgeons and"},{"speaker":"Chris Dy","startTime":314.24,"endTime":317.0,"body":"trainees. So what was the"},{"speaker":"Chris Dy","startTime":317.0,"endTime":321.02,"body":"question that Andy asked you"},{"speaker":"Chris Dy","startTime":317.0,"endTime":321.02,"body":"about your TFCC repair."},{"speaker":"Charles Goldfarb","startTime":322.49,"endTime":327.05,"body":"So I'm going"},{"speaker":"Charles Goldfarb","startTime":322.49,"endTime":327.05,"body":"to just quote him. And I kind of"},{"speaker":"Charles Goldfarb","startTime":327.05,"endTime":330.59,"body":"love all of this. He said,"},{"speaker":"Charles Goldfarb","startTime":327.05,"endTime":330.59,"body":"Chuck, I feel via the podcast I"},{"speaker":"Charles Goldfarb","startTime":330.59,"endTime":333.89,"body":"have come to know you, I enough"},{"speaker":"Charles Goldfarb","startTime":330.59,"endTime":333.89,"body":"to call you chuck with all the"},{"speaker":"Charles Goldfarb","startTime":333.89,"endTime":336.26,"body":"respect you deserve. Why don't"},{"speaker":"Charles Goldfarb","startTime":333.89,"endTime":336.26,"body":"have a deserve any respect, but"},{"speaker":"Charles Goldfarb","startTime":336.26,"endTime":340.13,"body":"I certainly welcome the first"},{"speaker":"Charles Goldfarb","startTime":336.26,"endTime":340.13,"body":"name basis. And then he said,"},{"speaker":"Charles Goldfarb","startTime":340.13,"endTime":343.43,"body":"First, I love the podcasts and"},{"speaker":"Charles Goldfarb","startTime":340.13,"endTime":343.43,"body":"just discovered and have binged"},{"speaker":"Charles Goldfarb","startTime":343.43,"endTime":346.82,"body":"on my 35 mile commute to and"},{"speaker":"Charles Goldfarb","startTime":343.43,"endTime":346.82,"body":"from work. I am working on a"},{"speaker":"Charles Goldfarb","startTime":346.82,"endTime":350.27,"body":"list of suggestions to come"},{"speaker":"Charles Goldfarb","startTime":346.82,"endTime":350.27,"body":"earlier. Thank you. We want"},{"speaker":"Charles Goldfarb","startTime":350.27,"endTime":353.9,"body":"suggestions. And we look forward"},{"speaker":"Charles Goldfarb","startTime":350.27,"endTime":353.9,"body":"to that list. And the question"},{"speaker":"Charles Goldfarb","startTime":353.9,"endTime":357.41,"body":"is, I don't think I understand"},{"speaker":"Charles Goldfarb","startTime":353.9,"endTime":357.41,"body":"exactly how you do your TFCC"},{"speaker":"Charles Goldfarb","startTime":357.41,"endTime":364.88,"body":"repair. And he has done an open"},{"speaker":"Charles Goldfarb","startTime":357.41,"endTime":364.88,"body":"repair, which sounds like it's"},{"speaker":"Charles Goldfarb","startTime":364.88,"endTime":368.0,"body":"pretty much like mine. And then"},{"speaker":"Charles Goldfarb","startTime":364.88,"endTime":368.0,"body":"we went back and forth on the"},{"speaker":"Charles Goldfarb","startTime":368.0,"endTime":372.83,"body":"technical. And I think that"},{"speaker":"Charles Goldfarb","startTime":368.0,"endTime":372.83,"body":"bears further emphasis. So there"},{"speaker":"Charles Goldfarb","startTime":372.83,"endTime":377.81,"body":"are sports hand surgeons out"},{"speaker":"Charles Goldfarb","startTime":372.83,"endTime":377.81,"body":"there. And Steve Shin is one of"},{"speaker":"Charles Goldfarb","startTime":384.02,"endTime":388.19,"body":"them. Steve is at Cedars Sinai"},{"speaker":"Charles Goldfarb","startTime":384.02,"endTime":388.19,"body":"in LA. Steve is clearly"},{"speaker":"Charles Goldfarb","startTime":388.37,"endTime":393.08,"body":"recognized as a sports surgeon,"},{"speaker":"Charles Goldfarb","startTime":388.37,"endTime":393.08,"body":"and I think you are going to or"},{"speaker":"Charles Goldfarb","startTime":393.11,"endTime":397.34,"body":"have just recently interviewed"},{"speaker":"Charles Goldfarb","startTime":393.11,"endTime":397.34,"body":"Steve for your podcast. But"},{"speaker":"Charles Goldfarb","startTime":397.34,"endTime":398.72,"body":"Steve does an open repair of"},{"speaker":"Charles Goldfarb","startTime":397.34,"endTime":398.72,"body":"TFCC injuries with a suture"},{"speaker":"Charles Goldfarb","startTime":398.72,"endTime":400.25,"body":"anchor for folio type repairs,"},{"speaker":"Charles Goldfarb","startTime":398.72,"endTime":400.25,"body":"and he has a slip technique and"},{"speaker":"Charles Goldfarb","startTime":400.25,"endTime":402.08,"body":"is very pleased with it. I"},{"speaker":"Charles Goldfarb","startTime":400.25,"endTime":402.08,"body":"really liked arthroscopic"},{"speaker":"Charles Goldfarb","startTime":402.08,"endTime":405.32,"body":"repair, I believe you get better"},{"speaker":"Charles Goldfarb","startTime":402.08,"endTime":405.32,"body":"visualization, I think you can"},{"speaker":"Charles Goldfarb","startTime":405.32,"endTime":409.28,"body":"be more technical with your"},{"speaker":"Charles Goldfarb","startTime":405.32,"endTime":409.28,"body":"suture placement. And so I think"},{"speaker":"Charles Goldfarb","startTime":409.28,"endTime":412.01,"body":"you could accomplish the same"},{"speaker":"Charles Goldfarb","startTime":409.28,"endTime":412.01,"body":"goals. And certainly, you know,"},{"speaker":"Charles Goldfarb","startTime":412.04,"endTime":415.31,"body":"surgeon comfort is incredibly"},{"speaker":"Charles Goldfarb","startTime":412.04,"endTime":415.31,"body":"important. It remains my"},{"speaker":"Charles Goldfarb","startTime":415.31,"endTime":417.11,"body":"preference to do these"},{"speaker":"Charles Goldfarb","startTime":415.31,"endTime":417.11,"body":"arthroscopically."},{"speaker":"Chris Dy","startTime":417.0,"endTime":420.75,"body":"Do you consider your"},{"speaker":"Chris Dy","startTime":417.0,"endTime":420.75,"body":"ulnar tunnel technique to be an"},{"speaker":"Chris Dy","startTime":420.75,"endTime":421.92,"body":"arthroscopic repair."},{"speaker":"Charles Goldfarb","startTime":422.33,"endTime":424.28,"body":"So that's"},{"speaker":"Charles Goldfarb","startTime":422.33,"endTime":424.28,"body":"super interesting. And that may"},{"speaker":"Charles Goldfarb","startTime":424.28,"endTime":430.55,"body":"tie into another conversation we"},{"speaker":"Charles Goldfarb","startTime":424.28,"endTime":430.55,"body":"have I consider an ulnar tunnel"},{"speaker":"Charles Goldfarb","startTime":430.55,"endTime":434.03,"body":"that is you know, drilling a"},{"speaker":"Charles Goldfarb","startTime":430.55,"endTime":434.03,"body":"short oblique tunnel through the"},{"speaker":"Charles Goldfarb","startTime":434.06,"endTime":437.45,"body":"ulna and bringing the sutures"},{"speaker":"Charles Goldfarb","startTime":434.06,"endTime":437.45,"body":"down and tethering the sutures"},{"speaker":"Charles Goldfarb","startTime":437.45,"endTime":440.72,"body":"to the bone to be an open"},{"speaker":"Charles Goldfarb","startTime":437.45,"endTime":440.72,"body":"assisted technique. So you know,"},{"speaker":"Charles Goldfarb","startTime":440.72,"endTime":444.89,"body":"the scope is in the joint the"},{"speaker":"Charles Goldfarb","startTime":440.72,"endTime":444.89,"body":"entire time, the scope and a"},{"speaker":"Charles Goldfarb","startTime":444.89,"endTime":449.33,"body":"probe are helping to assure"},{"speaker":"Charles Goldfarb","startTime":444.89,"endTime":449.33,"body":"exact placement of the sutures."},{"speaker":"Charles Goldfarb","startTime":449.48,"endTime":453.14,"body":"But ultimately, this is an open"},{"speaker":"Charles Goldfarb","startTime":449.48,"endTime":453.14,"body":"repair technique. And so I think"},{"speaker":"Charles Goldfarb","startTime":453.14,"endTime":456.32,"body":"it actually checks both boxes."},{"speaker":"Charles Goldfarb","startTime":453.14,"endTime":456.32,"body":"And the coding is interesting"},{"speaker":"Charles Goldfarb","startTime":456.32,"endTime":456.68,"body":"for it."},{"speaker":"Chris Dy","startTime":457.73,"endTime":460.01,"body":"Yeah, well, that"},{"speaker":"Chris Dy","startTime":457.73,"endTime":460.01,"body":"actually brings us to probably"},{"speaker":"Chris Dy","startTime":460.01,"endTime":461.87,"body":"our topic of discussion for"},{"speaker":"Chris Dy","startTime":460.01,"endTime":461.87,"body":"today. But I love that"},{"speaker":"Chris Dy","startTime":461.87,"endTime":465.08,"body":"technique, mainly because I"},{"speaker":"Chris Dy","startTime":461.87,"endTime":465.08,"body":"think you were doing it with"},{"speaker":"Chris Dy","startTime":465.08,"endTime":467.75,"body":"more frequency when I was"},{"speaker":"Chris Dy","startTime":465.08,"endTime":467.75,"body":"training with you, or you just"},{"speaker":"Chris Dy","startTime":467.75,"endTime":469.76,"body":"started to do it more. And I"},{"speaker":"Chris Dy","startTime":467.75,"endTime":469.76,"body":"really like it. And it's worked"},{"speaker":"Chris Dy","startTime":469.76,"endTime":474.23,"body":"for me as well. And it's pretty"},{"speaker":"Chris Dy","startTime":469.76,"endTime":474.23,"body":"intuitive. So perhaps one day, I"},{"speaker":"Chris Dy","startTime":474.23,"endTime":476.57,"body":"should really sit down with you"},{"speaker":"Chris Dy","startTime":474.23,"endTime":476.57,"body":"and kind of go through a true"},{"speaker":"Chris Dy","startTime":476.57,"endTime":478.94,"body":"open technique. But if I'm in"},{"speaker":"Chris Dy","startTime":476.57,"endTime":478.94,"body":"that kind of setting, I'm"},{"speaker":"Chris Dy","startTime":478.94,"endTime":480.62,"body":"probably sending that patient to"},{"speaker":"Chris Dy","startTime":478.94,"endTime":480.62,"body":"you anyway."},{"speaker":"Charles Goldfarb","startTime":481.28,"endTime":483.23,"body":"Well, I"},{"speaker":"Charles Goldfarb","startTime":481.28,"endTime":483.23,"body":"appreciate that. You know, it's,"},{"speaker":"Charles Goldfarb","startTime":483.74,"endTime":488.57,"body":"I'm in the middle of a study. I"},{"speaker":"Charles Goldfarb","startTime":483.74,"endTime":488.57,"body":"don't think that fovea TFCC"},{"speaker":"Charles Goldfarb","startTime":488.57,"endTime":492.95,"body":"tears, and I guess I should"},{"speaker":"Charles Goldfarb","startTime":488.57,"endTime":492.95,"body":"broaden that the wide expanse of"},{"speaker":"Charles Goldfarb","startTime":492.95,"endTime":496.31,"body":"TFC pathology, I don't think"},{"speaker":"Charles Goldfarb","startTime":492.95,"endTime":496.31,"body":"it's super well understood. And"},{"speaker":"Charles Goldfarb","startTime":496.31,"endTime":500.12,"body":"maybe that's maybe it's not well"},{"speaker":"Charles Goldfarb","startTime":496.31,"endTime":500.12,"body":"understood by me. But I think"},{"speaker":"Charles Goldfarb","startTime":500.12,"endTime":503.57,"body":"it's taken me years to really"},{"speaker":"Charles Goldfarb","startTime":500.12,"endTime":503.57,"body":"feel like I totally own it. And"},{"speaker":"Charles Goldfarb","startTime":503.57,"endTime":507.95,"body":"I think I do. But my sense is"},{"speaker":"Charles Goldfarb","startTime":503.57,"endTime":507.95,"body":"that if you know, we took a"},{"speaker":"Charles Goldfarb","startTime":507.95,"endTime":510.8,"body":"couple of surgeons from WashU,"},{"speaker":"Charles Goldfarb","startTime":507.95,"endTime":510.8,"body":"and a couple of surgeons from"},{"speaker":"Charles Goldfarb","startTime":510.8,"endTime":515.18,"body":"elsewhere, and compared our"},{"speaker":"Charles Goldfarb","startTime":510.8,"endTime":515.18,"body":"assessment, it would not be the"},{"speaker":"Charles Goldfarb","startTime":515.18,"endTime":517.13,"body":"same. So that's what we're about"},{"speaker":"Charles Goldfarb","startTime":515.18,"endTime":517.13,"body":"to do. There's one study out"},{"speaker":"Charles Goldfarb","startTime":517.13,"endTime":518.96,"body":"there doing this at a"},{"speaker":"Charles Goldfarb","startTime":517.13,"endTime":518.96,"body":"Philadelphia we're going to do"},{"speaker":"Charles Goldfarb","startTime":518.96,"endTime":523.19,"body":"it on a little bigger scale. We"},{"speaker":"Charles Goldfarb","startTime":518.96,"endTime":523.19,"body":"have about 40 arthroscopic"},{"speaker":"Charles Goldfarb","startTime":523.19,"endTime":526.13,"body":"videos and we're going to"},{"speaker":"Charles Goldfarb","startTime":523.19,"endTime":526.13,"body":"compare and contrast and try to"},{"speaker":"Charles Goldfarb","startTime":526.13,"endTime":529.37,"body":"see what people think about the"},{"speaker":"Charles Goldfarb","startTime":526.13,"endTime":529.37,"body":"diagnosis because you can't make"},{"speaker":"Charles Goldfarb","startTime":529.37,"endTime":534.98,"body":"the diagnosis in a way that is"},{"speaker":"Charles Goldfarb","startTime":529.37,"endTime":534.98,"body":"mutually agreed upon by all then"},{"speaker":"Charles Goldfarb","startTime":535.01,"endTime":538.52,"body":"obviously, treatments can be"},{"speaker":"Charles Goldfarb","startTime":535.01,"endTime":538.52,"body":"very different. So anyways,"},{"speaker":"Charles Goldfarb","startTime":538.67,"endTime":542.96,"body":"understanding that TFCC tear is"},{"speaker":"Charles Goldfarb","startTime":538.67,"endTime":542.96,"body":"the first step and then surgeon"},{"speaker":"Charles Goldfarb","startTime":542.96,"endTime":544.31,"body":"choice on treatment thereafter."},{"speaker":"Chris Dy","startTime":545.12,"endTime":546.62,"body":"I think your study is"},{"speaker":"Chris Dy","startTime":545.12,"endTime":546.62,"body":"gonna be really interesting. I"},{"speaker":"Chris Dy","startTime":546.62,"endTime":549.02,"body":"can't believe you're giving away"},{"speaker":"Chris Dy","startTime":546.62,"endTime":549.02,"body":"all of your wonderful study"},{"speaker":"Chris Dy","startTime":549.02,"endTime":550.73,"body":"ideas on the podcast."},{"speaker":"Charles Goldfarb","startTime":551.24,"endTime":553.7,"body":"Hey, more"},{"speaker":"Charles Goldfarb","startTime":551.24,"endTime":553.7,"body":"power to the listener who can"},{"speaker":"Charles Goldfarb","startTime":553.7,"endTime":558.62,"body":"make this happen quickly. It you"},{"speaker":"Charles Goldfarb","startTime":553.7,"endTime":558.62,"body":"know, I'm all about other people"},{"speaker":"Charles Goldfarb","startTime":558.62,"endTime":562.07,"body":"jumping in. This is a tough one,"},{"speaker":"Charles Goldfarb","startTime":558.62,"endTime":562.07,"body":"though, to get good videos and"},{"speaker":"Charles Goldfarb","startTime":562.37,"endTime":564.47,"body":"and reviewers it's taken us some"},{"speaker":"Charles Goldfarb","startTime":562.37,"endTime":564.47,"body":"time."},{"speaker":"Chris Dy","startTime":565.25,"endTime":567.05,"body":"I mean, there's"},{"speaker":"Chris Dy","startTime":565.25,"endTime":567.05,"body":"there's some really interesting"},{"speaker":"Chris Dy","startTime":567.05,"endTime":571.19,"body":"literature in parallel in the"},{"speaker":"Chris Dy","startTime":567.05,"endTime":571.19,"body":"general surgery, education space"},{"speaker":"Chris Dy","startTime":571.7,"endTime":574.1,"body":"along these lines, not"},{"speaker":"Chris Dy","startTime":571.7,"endTime":574.1,"body":"necessarily grading and"},{"speaker":"Chris Dy","startTime":574.1,"endTime":578.81,"body":"assessment, but also surgeons"},{"speaker":"Chris Dy","startTime":574.1,"endTime":578.81,"body":"skill in terms of sending in"},{"speaker":"Chris Dy","startTime":578.81,"endTime":582.77,"body":"videos of your laparoscopic"},{"speaker":"Chris Dy","startTime":578.81,"endTime":582.77,"body":"cholecystectomy and seeing how"},{"speaker":"Chris Dy","startTime":582.77,"endTime":585.05,"body":"efficiently move and having"},{"speaker":"Chris Dy","startTime":582.77,"endTime":585.05,"body":"somebody else graded and they"},{"speaker":"Chris Dy","startTime":585.05,"endTime":587.3,"body":"might have even incorporated"},{"speaker":"Chris Dy","startTime":585.05,"endTime":587.3,"body":"something like that into their"},{"speaker":"Chris Dy","startTime":587.3,"endTime":591.02,"body":"board certification process. I"},{"speaker":"Chris Dy","startTime":587.3,"endTime":591.02,"body":"think it's super interesting and"},{"speaker":"Chris Dy","startTime":592.58,"endTime":595.52,"body":"funny enough, somebody emailed"},{"speaker":"Chris Dy","startTime":592.58,"endTime":595.52,"body":"us saying that we both say super"},{"speaker":"Chris Dy","startTime":595.52,"endTime":600.47,"body":"interesting a lot. Just caught"},{"speaker":"Chris Dy","startTime":595.52,"endTime":600.47,"body":"myself doing that. You've got"},{"speaker":"Chris Dy","startTime":600.47,"endTime":604.22,"body":"your two things, and we both"},{"speaker":"Chris Dy","startTime":600.47,"endTime":604.22,"body":"have our super interesting. But"},{"speaker":"Chris Dy","startTime":604.22,"endTime":605.93,"body":"yes, yes. Super interesting"},{"speaker":"Chris Dy","startTime":604.22,"endTime":605.93,"body":"space."},{"speaker":"Charles Goldfarb","startTime":606.2,"endTime":607.82,"body":"Yeah, well,"},{"speaker":"Charles Goldfarb","startTime":606.2,"endTime":607.82,"body":"it's not just entertaining and"},{"speaker":"Charles Goldfarb","startTime":607.82,"endTime":612.32,"body":"super interesting. Um, I think"},{"speaker":"Charles Goldfarb","startTime":607.82,"endTime":612.32,"body":"that's fascinating. And we've"},{"speaker":"Charles Goldfarb","startTime":612.32,"endTime":616.94,"body":"had a brief discussion, I think"},{"speaker":"Charles Goldfarb","startTime":612.32,"endTime":616.94,"body":"early in the podcast about, you"},{"speaker":"Charles Goldfarb","startTime":616.94,"endTime":620.75,"body":"know, how do we continue to"},{"speaker":"Charles Goldfarb","startTime":616.94,"endTime":620.75,"body":"improve as surgeons, if we're"},{"speaker":"Charles Goldfarb","startTime":620.75,"endTime":624.14,"body":"not, you know, coached on"},{"speaker":"Charles Goldfarb","startTime":620.75,"endTime":624.14,"body":"surgical technique and"},{"speaker":"Charles Goldfarb","startTime":624.14,"endTime":627.44,"body":"individually assessed, and the"},{"speaker":"Charles Goldfarb","startTime":624.14,"endTime":627.44,"body":"your comment gets to the point"},{"speaker":"Charles Goldfarb","startTime":627.44,"endTime":630.8,"body":"of that, which is a whole nother"},{"speaker":"Charles Goldfarb","startTime":627.44,"endTime":630.8,"body":"level of discussion, but"},{"speaker":"Charles Goldfarb","startTime":631.82,"endTime":632.69,"body":"fascinating."},{"speaker":"Chris Dy","startTime":634.43,"endTime":637.34,"body":"So, to continue with"},{"speaker":"Chris Dy","startTime":634.43,"endTime":637.34,"body":"our mailbag theme for today's"},{"speaker":"Chris Dy","startTime":637.34,"endTime":641.51,"body":"episode, there was a great email"},{"speaker":"Chris Dy","startTime":637.34,"endTime":641.51,"body":"from Cal Shaw, who is a listen"},{"speaker":"Chris Dy","startTime":641.51,"endTime":644.63,"body":"to podcast for a long time, and"},{"speaker":"Chris Dy","startTime":641.51,"endTime":644.63,"body":"we appreciate that cow. And he"},{"speaker":"Chris Dy","startTime":644.63,"endTime":648.92,"body":"emailed it was a little bit ago,"},{"speaker":"Chris Dy","startTime":644.63,"endTime":648.92,"body":"but a question about coding. And"},{"speaker":"Chris Dy","startTime":648.92,"endTime":655.28,"body":"he was talking about how we code"},{"speaker":"Chris Dy","startTime":648.92,"endTime":655.28,"body":"potentially for a ganglion cyst?"},{"speaker":"Chris Dy","startTime":655.94,"endTime":659.81,"body":"Do you code for an arthrotomy?"},{"speaker":"Chris Dy","startTime":655.94,"endTime":659.81,"body":"Do you do anything for a capsule"},{"speaker":"Chris Dy","startTime":659.81,"endTime":663.56,"body":"or fee? And then just in"},{"speaker":"Chris Dy","startTime":659.81,"endTime":663.56,"body":"general, just some discussions"},{"speaker":"Chris Dy","startTime":663.56,"endTime":666.2,"body":"about coding and thoughts. Do"},{"speaker":"Chris Dy","startTime":663.56,"endTime":666.2,"body":"you have any thoughts on that?"},{"speaker":"Chris Dy","startTime":666.2,"endTime":666.44,"body":"Chuck?"},{"speaker":"Charles Goldfarb","startTime":666.99,"endTime":670.8,"body":"Yeah, if I"},{"speaker":"Charles Goldfarb","startTime":666.99,"endTime":670.8,"body":"may, I think, you know, if this"},{"speaker":"Charles Goldfarb","startTime":670.8,"endTime":675.33,"body":"is something, then judge me if"},{"speaker":"Charles Goldfarb","startTime":670.8,"endTime":675.33,"body":"you must, that I enjoy. I think"},{"speaker":"Charles Goldfarb","startTime":675.33,"endTime":678.12,"body":"the coding process is"},{"speaker":"Charles Goldfarb","startTime":675.33,"endTime":678.12,"body":"interesting. It's certainly"},{"speaker":"Charles Goldfarb","startTime":678.12,"endTime":682.68,"body":"controversial. And I want to I"},{"speaker":"Charles Goldfarb","startTime":678.12,"endTime":682.68,"body":"know, we both want to touch on a"},{"speaker":"Charles Goldfarb","startTime":682.68,"endTime":688.71,"body":"recent study and JHSGO. But I"},{"speaker":"Charles Goldfarb","startTime":682.68,"endTime":688.71,"body":"think coding perspective,"},{"speaker":"Charles Goldfarb","startTime":688.8,"endTime":695.67,"body":"unfortunately, is colored a bit"},{"speaker":"Charles Goldfarb","startTime":688.8,"endTime":695.67,"body":"by practice setting. And"},{"speaker":"Charles Goldfarb","startTime":695.79,"endTime":698.76,"body":"probably honestly, not"},{"speaker":"Charles Goldfarb","startTime":695.79,"endTime":698.76,"body":"surprising to understand that."},{"speaker":"Charles Goldfarb","startTime":699.3,"endTime":705.96,"body":"But surgeons who are reimbursed"},{"speaker":"Charles Goldfarb","startTime":699.3,"endTime":705.96,"body":"based on RVUs or collections"},{"speaker":"Charles Goldfarb","startTime":706.2,"endTime":709.59,"body":"code more aggressively, if"},{"speaker":"Charles Goldfarb","startTime":706.2,"endTime":709.59,"body":"that's the right word, and"},{"speaker":"Charles Goldfarb","startTime":709.59,"endTime":713.97,"body":"salaried surgeons are less"},{"speaker":"Charles Goldfarb","startTime":709.59,"endTime":713.97,"body":"likely to do so. And that,"},{"speaker":"Charles Goldfarb","startTime":713.97,"endTime":716.61,"body":"obviously, is not the way it"},{"speaker":"Charles Goldfarb","startTime":713.97,"endTime":716.61,"body":"should be. But I kind of"},{"speaker":"Charles Goldfarb","startTime":716.61,"endTime":721.29,"body":"understand it. I think, you"},{"speaker":"Charles Goldfarb","startTime":716.61,"endTime":721.29,"body":"know, you and I are certainly in"},{"speaker":"Charles Goldfarb","startTime":721.29,"endTime":725.7,"body":"an academic situation. But we"},{"speaker":"Charles Goldfarb","startTime":721.29,"endTime":725.7,"body":"are reimbursed based on"},{"speaker":"Charles Goldfarb","startTime":725.7,"endTime":730.05,"body":"collections and RVUs. And so we"},{"speaker":"Charles Goldfarb","startTime":725.7,"endTime":730.05,"body":"might be thrown into that latter"},{"speaker":"Charles Goldfarb","startTime":730.05,"endTime":733.74,"body":"group, although I think we both"},{"speaker":"Charles Goldfarb","startTime":730.05,"endTime":733.74,"body":"take this seriously. And code"},{"speaker":"Charles Goldfarb","startTime":733.74,"endTime":738.18,"body":"carefully. And certainly don't"},{"speaker":"Charles Goldfarb","startTime":733.74,"endTime":738.18,"body":"want to overdo it. So as before"},{"speaker":"Charles Goldfarb","startTime":738.18,"endTime":742.11,"body":"adopt jumped into this specific"},{"speaker":"Charles Goldfarb","startTime":738.18,"endTime":742.11,"body":"example, we can pick a few. What"},{"speaker":"Charles Goldfarb","startTime":742.11,"endTime":744.54,"body":"do you think about that general"},{"speaker":"Charles Goldfarb","startTime":742.11,"endTime":744.54,"body":"statement? Does that resonate?"},{"speaker":"Chris Dy","startTime":745.35,"endTime":747.51,"body":"Yeah, I mean, I think"},{"speaker":"Chris Dy","startTime":745.35,"endTime":747.51,"body":"yes, it's really important for"},{"speaker":"Chris Dy","startTime":747.51,"endTime":751.53,"body":"the listeners to understand our"},{"speaker":"Chris Dy","startTime":747.51,"endTime":751.53,"body":"context. And you know, the fact"},{"speaker":"Chris Dy","startTime":751.53,"endTime":754.5,"body":"that we have base salaries, and"},{"speaker":"Chris Dy","startTime":751.53,"endTime":754.5,"body":"then we are additional"},{"speaker":"Chris Dy","startTime":754.5,"endTime":757.74,"body":"compensation based on"},{"speaker":"Chris Dy","startTime":754.5,"endTime":757.74,"body":"collections and our views, and"},{"speaker":"Chris Dy","startTime":757.8,"endTime":761.46,"body":"you know, that kind of thing."},{"speaker":"Chris Dy","startTime":757.8,"endTime":761.46,"body":"I'll be honest with you, I don't"},{"speaker":"Chris Dy","startTime":761.46,"endTime":764.43,"body":"pay attention to it as much as I"},{"speaker":"Chris Dy","startTime":761.46,"endTime":764.43,"body":"probably should. I know I"},{"speaker":"Chris Dy","startTime":764.43,"endTime":768.18,"body":"should. But I don't. And it's"},{"speaker":"Chris Dy","startTime":764.43,"endTime":768.18,"body":"one of those things where I do"},{"speaker":"Chris Dy","startTime":768.18,"endTime":771.54,"body":"the work, I dictate what I do."},{"speaker":"Chris Dy","startTime":768.18,"endTime":771.54,"body":"And I kind of just let the"},{"speaker":"Chris Dy","startTime":771.54,"endTime":775.74,"body":"coders do their thing. You know,"},{"speaker":"Chris Dy","startTime":771.54,"endTime":775.74,"body":"I probably should pay more"},{"speaker":"Chris Dy","startTime":775.74,"endTime":778.71,"body":"attention to it. Like, for"},{"speaker":"Chris Dy","startTime":775.74,"endTime":778.71,"body":"example, like when David Brogan"},{"speaker":"Chris Dy","startTime":778.71,"endTime":782.1,"body":"and I do a plexus together, I"},{"speaker":"Chris Dy","startTime":778.71,"endTime":782.1,"body":"trust him to tell me how we"},{"speaker":"Chris Dy","startTime":782.1,"endTime":784.41,"body":"should split everything up"},{"speaker":"Chris Dy","startTime":782.1,"endTime":784.41,"body":"because he knows all this stuff."},{"speaker":"Chris Dy","startTime":784.89,"endTime":788.43,"body":"Because either he is interested"},{"speaker":"Chris Dy","startTime":784.89,"endTime":788.43,"body":"in it, or I think in his prior"},{"speaker":"Chris Dy","startTime":788.46,"endTime":791.61,"body":"practice setting when he was at"},{"speaker":"Chris Dy","startTime":788.46,"endTime":791.61,"body":"Mizzou, he paid closer attention"},{"speaker":"Chris Dy","startTime":791.61,"endTime":796.02,"body":"to it. I honestly don't want to"},{"speaker":"Chris Dy","startTime":791.61,"endTime":796.02,"body":"get into the weeds on that."},{"speaker":"Chris Dy","startTime":797.22,"endTime":800.13,"body":"Again, knowing that I should no"},{"speaker":"Chris Dy","startTime":797.22,"endTime":800.13,"body":"more but there are many other"},{"speaker":"Chris Dy","startTime":800.13,"endTime":801.57,"body":"things that I have going on in"},{"speaker":"Chris Dy","startTime":800.13,"endTime":801.57,"body":"my head."},{"speaker":"Charles Goldfarb","startTime":802.41,"endTime":805.29,"body":"So let's be"},{"speaker":"Charles Goldfarb","startTime":802.41,"endTime":805.29,"body":"clear for residents who might be"},{"speaker":"Charles Goldfarb","startTime":805.29,"endTime":809.46,"body":"listening and fellows who might"},{"speaker":"Charles Goldfarb","startTime":805.29,"endTime":809.46,"body":"be listening, even young. You"},{"speaker":"Charles Goldfarb","startTime":809.46,"endTime":813.0,"body":"know, attendings who might be"},{"speaker":"Charles Goldfarb","startTime":809.46,"endTime":813.0,"body":"listening, ultimately, you can"},{"speaker":"Charles Goldfarb","startTime":813.0,"endTime":818.1,"body":"have coders and many of us do."},{"speaker":"Charles Goldfarb","startTime":813.0,"endTime":818.1,"body":"But ultimately, it is your"},{"speaker":"Charles Goldfarb","startTime":818.1,"endTime":821.73,"body":"responsibility to code"},{"speaker":"Charles Goldfarb","startTime":818.1,"endTime":821.73,"body":"correctly. And, you know,"},{"speaker":"Charles Goldfarb","startTime":821.73,"endTime":825.54,"body":"fraudulent activity, intentional"},{"speaker":"Charles Goldfarb","startTime":821.73,"endTime":825.54,"body":"or not intentional, intentional"},{"speaker":"Charles Goldfarb","startTime":825.54,"endTime":829.17,"body":"comes back on you. So Chris and"},{"speaker":"Charles Goldfarb","startTime":825.54,"endTime":829.17,"body":"I are very fortunate that we"},{"speaker":"Charles Goldfarb","startTime":829.17,"endTime":832.56,"body":"have a wonderful group of coders"},{"speaker":"Charles Goldfarb","startTime":829.17,"endTime":832.56,"body":"that are subspecialized. But I"},{"speaker":"Charles Goldfarb","startTime":832.56,"endTime":837.45,"body":"review my codes every month. And"},{"speaker":"Charles Goldfarb","startTime":832.56,"endTime":837.45,"body":"there's never major issues, but"},{"speaker":"Charles Goldfarb","startTime":837.45,"endTime":840.03,"body":"I would say 10% of the time I"},{"speaker":"Charles Goldfarb","startTime":837.45,"endTime":840.03,"body":"have a question or we have a"},{"speaker":"Charles Goldfarb","startTime":840.57,"endTime":844.65,"body":"subsequent discussion about"},{"speaker":"Charles Goldfarb","startTime":840.57,"endTime":844.65,"body":"coding, again, simply because I"},{"speaker":"Charles Goldfarb","startTime":844.65,"endTime":847.56,"body":"like it and want to get it"},{"speaker":"Charles Goldfarb","startTime":844.65,"endTime":847.56,"body":"right. I do. I do strongly feel"},{"speaker":"Charles Goldfarb","startTime":847.71,"endTime":853.14,"body":"that, you know, we as doctors,"},{"speaker":"Charles Goldfarb","startTime":847.71,"endTime":853.14,"body":"and we as surgeons, are entitled"},{"speaker":"Charles Goldfarb","startTime":853.23,"endTime":857.1,"body":"to reimbursement appropriate"},{"speaker":"Charles Goldfarb","startTime":853.23,"endTime":857.1,"body":"reimbursement for the work that"},{"speaker":"Charles Goldfarb","startTime":857.1,"endTime":861.12,"body":"we do, but no one's going to"},{"speaker":"Charles Goldfarb","startTime":857.1,"endTime":861.12,"body":"hand it to me. And so I have to"},{"speaker":"Charles Goldfarb","startTime":861.12,"endTime":864.66,"body":"be prepared to ask for it and"},{"speaker":"Charles Goldfarb","startTime":861.12,"endTime":864.66,"body":"get it. And I feel really"},{"speaker":"Charles Goldfarb","startTime":864.66,"endTime":868.23,"body":"strongly about that. And I think"},{"speaker":"Charles Goldfarb","startTime":864.66,"endTime":868.23,"body":"you know, this silly process of"},{"speaker":"Charles Goldfarb","startTime":868.23,"endTime":871.32,"body":"coding is is part of the game we"},{"speaker":"Charles Goldfarb","startTime":868.23,"endTime":871.32,"body":"play in it, it was a game."},{"speaker":"Chris Dy","startTime":872.19,"endTime":876.93,"body":"So to quote you do"},{"speaker":"Chris Dy","startTime":872.19,"endTime":876.93,"body":"things as mainly as questions"},{"speaker":"Chris Dy","startTime":876.93,"endTime":882.33,"body":"but that's just wanted to get"},{"speaker":"Chris Dy","startTime":876.93,"endTime":882.33,"body":"that do you think so put on your"},{"speaker":"Chris Dy","startTime":882.33,"endTime":888.24,"body":"hat as vice chair now. Do you?"},{"speaker":"Chris Dy","startTime":882.33,"endTime":888.24,"body":"What percentage of our surgical"},{"speaker":"Chris Dy","startTime":888.24,"endTime":891.63,"body":"faculty do you think actually go"},{"speaker":"Chris Dy","startTime":888.24,"endTime":891.63,"body":"through the process that you"},{"speaker":"Chris Dy","startTime":891.63,"endTime":893.58,"body":"just described looking at your"},{"speaker":"Chris Dy","startTime":891.63,"endTime":893.58,"body":"codes every month?"},{"speaker":"Charles Goldfarb","startTime":894.51,"endTime":897.48,"body":"Geez, I wonder"},{"speaker":"Charles Goldfarb","startTime":894.51,"endTime":897.48,"body":"if I should disclose this but I"},{"speaker":"Charles Goldfarb","startTime":897.48,"endTime":902.04,"body":"will say conservatively it is"},{"speaker":"Charles Goldfarb","startTime":897.48,"endTime":902.04,"body":"less than one in five, who do"},{"speaker":"Charles Goldfarb","startTime":902.04,"endTime":906.33,"body":"this every month, it is a again,"},{"speaker":"Charles Goldfarb","startTime":902.04,"endTime":906.33,"body":"we all choose different practice"},{"speaker":"Charles Goldfarb","startTime":906.33,"endTime":910.2,"body":"settings for different reasons."},{"speaker":"Charles Goldfarb","startTime":906.33,"endTime":910.2,"body":"The protected environment of"},{"speaker":"Charles Goldfarb","startTime":910.2,"endTime":914.94,"body":"academia is no longer what it"},{"speaker":"Charles Goldfarb","startTime":910.2,"endTime":914.94,"body":"used to be. But some of it is."},{"speaker":"Charles Goldfarb","startTime":914.97,"endTime":917.43,"body":"Some of it is we, you know, I"},{"speaker":"Charles Goldfarb","startTime":914.97,"endTime":917.43,"body":"just don't like dealing with"},{"speaker":"Charles Goldfarb","startTime":917.43,"endTime":920.01,"body":"this. I have lots of other"},{"speaker":"Charles Goldfarb","startTime":917.43,"endTime":920.01,"body":"things on my plate, but it's a"},{"speaker":"Charles Goldfarb","startTime":920.01,"endTime":923.73,"body":"minority of us who actually look"},{"speaker":"Charles Goldfarb","startTime":920.01,"endTime":923.73,"body":"at the coding and double check"},{"speaker":"Charles Goldfarb","startTime":923.73,"endTime":924.63,"body":"it prior to submission."},{"speaker":"Chris Dy","startTime":925.41,"endTime":928.8,"body":"Yeah, I mean, there's"},{"speaker":"Chris Dy","startTime":925.41,"endTime":928.8,"body":"incredible variability or"},{"speaker":"Chris Dy","startTime":928.83,"endTime":933.54,"body":"heterogeneity and how we would"},{"speaker":"Chris Dy","startTime":928.83,"endTime":933.54,"body":"code something, I've seen it at"},{"speaker":"Chris Dy","startTime":933.54,"endTime":935.64,"body":"least I don't know how it goes"},{"speaker":"Chris Dy","startTime":933.54,"endTime":935.64,"body":"in terms of the codes. But I've"},{"speaker":"Chris Dy","startTime":935.64,"endTime":938.25,"body":"seen different for example, in"},{"speaker":"Chris Dy","startTime":935.64,"endTime":938.25,"body":"peripheral nerves, I've seen"},{"speaker":"Chris Dy","startTime":938.25,"endTime":941.76,"body":"different surgeons at our"},{"speaker":"Chris Dy","startTime":938.25,"endTime":941.76,"body":"institution, how they list out"},{"speaker":"Chris Dy","startTime":941.76,"endTime":944.07,"body":"their procedures, and I don't"},{"speaker":"Chris Dy","startTime":941.76,"endTime":944.07,"body":"know, again, if they're all"},{"speaker":"Chris Dy","startTime":944.07,"endTime":946.2,"body":"getting coded the way that"},{"speaker":"Chris Dy","startTime":944.07,"endTime":946.2,"body":"they're getting listed in the OP"},{"speaker":"Chris Dy","startTime":946.2,"endTime":950.01,"body":"note, but for nerve transfer,"},{"speaker":"Chris Dy","startTime":946.2,"endTime":950.01,"body":"you know, listing out a neuro"},{"speaker":"Chris Dy","startTime":950.01,"endTime":953.64,"body":"lyse an internal neuro lysis, in"},{"speaker":"Chris Dy","startTime":950.01,"endTime":953.64,"body":"addition to the nerve transfer"},{"speaker":"Chris Dy","startTime":953.64,"endTime":956.58,"body":"itself, in addition to"},{"speaker":"Chris Dy","startTime":953.64,"endTime":956.58,"body":"decompressions, and all the"},{"speaker":"Chris Dy","startTime":956.58,"endTime":958.65,"body":"other stuff. So I mean, there"},{"speaker":"Chris Dy","startTime":956.58,"endTime":958.65,"body":"are a lot of ways you could do I"},{"speaker":"Chris Dy","startTime":958.65,"endTime":961.11,"body":"mean, yes, technically, that is"},{"speaker":"Chris Dy","startTime":958.65,"endTime":961.11,"body":"part of the work. But you know,"},{"speaker":"Chris Dy","startTime":961.14,"endTime":963.84,"body":"ultimately, what is supposed to"},{"speaker":"Chris Dy","startTime":961.14,"endTime":963.84,"body":"be included in that one single"},{"speaker":"Chris Dy","startTime":963.84,"endTime":965.34,"body":"code for a nerve transfer."},{"speaker":"Charles Goldfarb","startTime":966.09,"endTime":968.88,"body":"So great"},{"speaker":"Charles Goldfarb","startTime":966.09,"endTime":968.88,"body":"point, I want to emphasize two"},{"speaker":"Charles Goldfarb","startTime":968.88,"endTime":973.17,"body":"things. The first is that, you"},{"speaker":"Charles Goldfarb","startTime":968.88,"endTime":973.17,"body":"know, it may I think this is"},{"speaker":"Charles Goldfarb","startTime":973.17,"endTime":976.65,"body":"gonna make you feel better about"},{"speaker":"Charles Goldfarb","startTime":973.17,"endTime":976.65,"body":"your choice to not review this,"},{"speaker":"Charles Goldfarb","startTime":976.65,"endTime":980.16,"body":"but our coders read every word"},{"speaker":"Charles Goldfarb","startTime":976.65,"endTime":980.16,"body":"of every op note. It's"},{"speaker":"Charles Goldfarb","startTime":980.16,"endTime":983.61,"body":"unbelievable to me. It's not"},{"speaker":"Charles Goldfarb","startTime":980.16,"endTime":983.61,"body":"like they're reading what our"},{"speaker":"Charles Goldfarb","startTime":983.61,"endTime":986.01,"body":"procedure is, they're reading"},{"speaker":"Charles Goldfarb","startTime":983.61,"endTime":986.01,"body":"our procedure and making sure we"},{"speaker":"Charles Goldfarb","startTime":986.01,"endTime":990.21,"body":"justify it. I mean, it's"},{"speaker":"Charles Goldfarb","startTime":986.01,"endTime":990.21,"body":"awesome. The second is the hands"},{"speaker":"Charles Goldfarb","startTime":990.21,"endTime":994.05,"body":"society has a Global Services"},{"speaker":"Charles Goldfarb","startTime":990.21,"endTime":994.05,"body":"Guide, which I don't know the"},{"speaker":"Charles Goldfarb","startTime":994.05,"endTime":998.19,"body":"last time it was published. And"},{"speaker":"Charles Goldfarb","startTime":994.05,"endTime":998.19,"body":"maybe we should reevaluate it as"},{"speaker":"Charles Goldfarb","startTime":998.19,"endTime":1001.97,"body":"a as an organization. But it is"},{"speaker":"Charles Goldfarb","startTime":998.19,"endTime":1001.97,"body":"wonderful. So it takes every CPT"},{"speaker":"Charles Goldfarb","startTime":1001.97,"endTime":1006.32,"body":"code. So for example, let's say,"},{"speaker":"Charles Goldfarb","startTime":1001.97,"endTime":1006.32,"body":"one of your favorites, 64718. So"},{"speaker":"Charles Goldfarb","startTime":1006.41,"endTime":1010.04,"body":"ulnar nerve decompression or"},{"speaker":"Charles Goldfarb","startTime":1006.41,"endTime":1010.04,"body":"transposition, and it lists out"},{"speaker":"Charles Goldfarb","startTime":1010.04,"endTime":1013.43,"body":"what's included in that code and"},{"speaker":"Charles Goldfarb","startTime":1010.04,"endTime":1013.43,"body":"what's excluded in that code."},{"speaker":"Charles Goldfarb","startTime":1013.7,"endTime":1017.54,"body":"And, again, for those of you"},{"speaker":"Charles Goldfarb","startTime":1013.7,"endTime":1017.54,"body":"starting out in practice, it's"},{"speaker":"Charles Goldfarb","startTime":1017.54,"endTime":1020.93,"body":"really helpful to have that as a"},{"speaker":"Charles Goldfarb","startTime":1017.54,"endTime":1020.93,"body":"resource to make sure you"},{"speaker":"Charles Goldfarb","startTime":1020.93,"endTime":1025.1,"body":"understand that you're not"},{"speaker":"Charles Goldfarb","startTime":1020.93,"endTime":1025.1,"body":"unbundling, and you're coding"},{"speaker":"Charles Goldfarb","startTime":1025.4,"endTime":1029.54,"body":"maximally appropriately, to get"},{"speaker":"Charles Goldfarb","startTime":1025.4,"endTime":1029.54,"body":"what's due to you."},{"speaker":"Chris Dy","startTime":1030.41,"endTime":1033.95,"body":"So I never got to get"},{"speaker":"Chris Dy","startTime":1030.41,"endTime":1033.95,"body":"to my second point of my gopher"},{"speaker":"Chris Dy","startTime":1033.95,"endTime":1039.23,"body":"thing. So of the you said, you"},{"speaker":"Chris Dy","startTime":1033.95,"endTime":1039.23,"body":"know, there may be 10% of cases"},{"speaker":"Chris Dy","startTime":1039.23,"endTime":1041.09,"body":"or something that you review"},{"speaker":"Chris Dy","startTime":1039.23,"endTime":1041.09,"body":"that maybe there are some"},{"speaker":"Chris Dy","startTime":1041.09,"endTime":1044.36,"body":"questions on how it was coded?"},{"speaker":"Chris Dy","startTime":1041.09,"endTime":1044.36,"body":"What are the usually the issues"},{"speaker":"Chris Dy","startTime":1044.36,"endTime":1046.58,"body":"that come up? Are there any"},{"speaker":"Chris Dy","startTime":1044.36,"endTime":1046.58,"body":"common themes?"},{"speaker":"Charles Goldfarb","startTime":1047.69,"endTime":1051.26,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1047.69,"endTime":1051.26,"body":"they're, they're, well, what's,"},{"speaker":"Charles Goldfarb","startTime":1051.44,"endTime":1053.75,"body":"again, I don't want to keep"},{"speaker":"Charles Goldfarb","startTime":1051.44,"endTime":1053.75,"body":"referring to paper we're going"},{"speaker":"Charles Goldfarb","startTime":1053.75,"endTime":1057.02,"body":"to discuss but, you know, there"},{"speaker":"Charles Goldfarb","startTime":1053.75,"endTime":1057.02,"body":"are certain percentage of codes"},{"speaker":"Charles Goldfarb","startTime":1057.02,"endTime":1061.82,"body":"that are super straightforward."},{"speaker":"Charles Goldfarb","startTime":1057.02,"endTime":1061.82,"body":"You know, although maybe not as"},{"speaker":"Charles Goldfarb","startTime":1061.82,"endTime":1064.1,"body":"straightforward as I thought,"},{"speaker":"Charles Goldfarb","startTime":1061.82,"endTime":1064.1,"body":"but but like carpal tunnel,"},{"speaker":"Charles Goldfarb","startTime":1064.1,"endTime":1067.49,"body":"release 64721. No problem. We"},{"speaker":"Charles Goldfarb","startTime":1064.1,"endTime":1067.49,"body":"all know what that is. I think"},{"speaker":"Charles Goldfarb","startTime":1067.49,"endTime":1071.0,"body":"it's when we get to the unusual"},{"speaker":"Charles Goldfarb","startTime":1067.49,"endTime":1071.0,"body":"things. And in your example of a"},{"speaker":"Charles Goldfarb","startTime":1071.0,"endTime":1074.75,"body":"plexus procedure, or nerve"},{"speaker":"Charles Goldfarb","startTime":1071.0,"endTime":1074.75,"body":"transfer procedure, it is"},{"speaker":"Charles Goldfarb","startTime":1074.75,"endTime":1079.13,"body":"certainly one of those. That's"},{"speaker":"Charles Goldfarb","startTime":1074.75,"endTime":1079.13,"body":"when things get a little hairy."},{"speaker":"Charles Goldfarb","startTime":1079.19,"endTime":1083.06,"body":"So for me, it's when I do a"},{"speaker":"Charles Goldfarb","startTime":1079.19,"endTime":1083.06,"body":"procedure that we none of the"},{"speaker":"Charles Goldfarb","startTime":1083.06,"endTime":1085.91,"body":"six about to be seven of us do"},{"speaker":"Charles Goldfarb","startTime":1083.06,"endTime":1085.91,"body":"on a regular basis. That's a"},{"speaker":"Charles Goldfarb","startTime":1085.91,"endTime":1089.18,"body":"little outside the box that just"},{"speaker":"Charles Goldfarb","startTime":1085.91,"endTime":1089.18,"body":"needs clarification. And"},{"speaker":"Charles Goldfarb","startTime":1089.18,"endTime":1093.08,"body":"sometimes I question it, and I'm"},{"speaker":"Charles Goldfarb","startTime":1089.18,"endTime":1093.08,"body":"wrong. Because of coders to have"},{"speaker":"Charles Goldfarb","startTime":1093.08,"endTime":1095.63,"body":"thoughtfully considered"},{"speaker":"Charles Goldfarb","startTime":1093.08,"endTime":1095.63,"body":"everything. And sometimes, I'm"},{"speaker":"Charles Goldfarb","startTime":1095.63,"endTime":1100.31,"body":"right, the other issue or"},{"speaker":"Charles Goldfarb","startTime":1095.63,"endTime":1100.31,"body":"unlisted codes. And so that"},{"speaker":"Charles Goldfarb","startTime":1100.31,"endTime":1104.42,"body":"might be a CMC arthroscopy or,"},{"speaker":"Charles Goldfarb","startTime":1100.31,"endTime":1104.42,"body":"you know, there are codes for"},{"speaker":"Charles Goldfarb","startTime":1104.42,"endTime":1107.51,"body":"small joint arthroscopy, but"},{"speaker":"Charles Goldfarb","startTime":1104.42,"endTime":1107.51,"body":"those things are are not coded"},{"speaker":"Charles Goldfarb","startTime":1107.51,"endTime":1110.24,"body":"regularly. So you need to find"},{"speaker":"Charles Goldfarb","startTime":1107.51,"endTime":1110.24,"body":"comparison codes, etc, etc."},{"speaker":"Chris Dy","startTime":1110.9,"endTime":1114.11,"body":"So Cal asked about"},{"speaker":"Chris Dy","startTime":1110.9,"endTime":1114.11,"body":"common surgeries and how you"},{"speaker":"Chris Dy","startTime":1114.11,"endTime":1119.51,"body":"would code them. So how would"},{"speaker":"Chris Dy","startTime":1114.11,"endTime":1119.51,"body":"you code a sub muscular ulnar"},{"speaker":"Chris Dy","startTime":1119.51,"endTime":1120.62,"body":"nerve transposition?"},{"speaker":"Charles Goldfarb","startTime":1122.09,"endTime":1124.76,"body":"Yeah, and then"},{"speaker":"Charles Goldfarb","startTime":1122.09,"endTime":1124.76,"body":"let we all answer this one, I"},{"speaker":"Charles Goldfarb","startTime":1124.76,"endTime":1127.28,"body":"want you to answer this No, no,"},{"speaker":"Charles Goldfarb","startTime":1124.76,"endTime":1127.28,"body":"let's go back to the dorsal root"},{"speaker":"Charles Goldfarb","startTime":1127.28,"endTime":1132.44,"body":"ganglion or risk ganglion of his"},{"speaker":"Charles Goldfarb","startTime":1127.28,"endTime":1132.44,"body":"original question. So for a sub"},{"speaker":"Charles Goldfarb","startTime":1132.47,"endTime":1135.68,"body":"muscular ulnar nerve"},{"speaker":"Charles Goldfarb","startTime":1132.47,"endTime":1135.68,"body":"transmission, I would code"},{"speaker":"Charles Goldfarb","startTime":1135.68,"endTime":1140.39,"body":"64718. That's the addressing the"},{"speaker":"Charles Goldfarb","startTime":1135.68,"endTime":1140.39,"body":"ulnar nerve and I would code"},{"speaker":"Charles Goldfarb","startTime":1140.39,"endTime":1145.52,"body":"lengthening of the flexor"},{"speaker":"Charles Goldfarb","startTime":1140.39,"endTime":1145.52,"body":"pronator, mass 24305. And so I"},{"speaker":"Charles Goldfarb","startTime":1145.52,"endTime":1149.27,"body":"happen to do as the lengthening"},{"speaker":"Charles Goldfarb","startTime":1145.52,"endTime":1149.27,"body":"of the mass, but we're cutting"},{"speaker":"Charles Goldfarb","startTime":1149.27,"endTime":1153.47,"body":"and repairing the flesh burning"},{"speaker":"Charles Goldfarb","startTime":1149.27,"endTime":1153.47,"body":"mass to me, merits different"},{"speaker":"Charles Goldfarb","startTime":1153.47,"endTime":1157.85,"body":"code. I don't code for anything"},{"speaker":"Charles Goldfarb","startTime":1153.47,"endTime":1157.85,"body":"else. Any other atoms I don't"},{"speaker":"Charles Goldfarb","startTime":1157.85,"endTime":1160.58,"body":"really think others do. And this"},{"speaker":"Charles Goldfarb","startTime":1157.85,"endTime":1160.58,"body":"one, I'm sure I'm wrong. I'm"},{"speaker":"Charles Goldfarb","startTime":1160.58,"endTime":1162.5,"body":"sure there's some people who"},{"speaker":"Charles Goldfarb","startTime":1160.58,"endTime":1162.5,"body":"would hopefully will comment,"},{"speaker":"Charles Goldfarb","startTime":1162.71,"endTime":1165.02,"body":"but those are the two basic"},{"speaker":"Charles Goldfarb","startTime":1162.71,"endTime":1165.02,"body":"codes for me. What about you?"},{"speaker":"Chris Dy","startTime":1165.02,"endTime":1167.9,"body":"How frequently, well,"},{"speaker":"Chris Dy","startTime":1165.02,"endTime":1167.9,"body":"first, I mean, how frequently do"},{"speaker":"Chris Dy","startTime":1167.9,"endTime":1172.07,"body":"you think you get the"},{"speaker":"Chris Dy","startTime":1167.9,"endTime":1172.07,"body":"reimbursement for the for the Z"},{"speaker":"Chris Dy","startTime":1172.07,"endTime":1172.82,"body":"lengthening code?"},{"speaker":"Charles Goldfarb","startTime":1173.11,"endTime":1175.12,"body":"Isn't that a"},{"speaker":"Charles Goldfarb","startTime":1173.11,"endTime":1175.12,"body":"fascinating question as much as"},{"speaker":"Charles Goldfarb","startTime":1175.12,"endTime":1179.8,"body":"I mentioned in this, I do not"},{"speaker":"Charles Goldfarb","startTime":1175.12,"endTime":1179.8,"body":"know, but the coders continue to"},{"speaker":"Charles Goldfarb","startTime":1180.04,"endTime":1186.25,"body":"agree with that approach. I am"},{"speaker":"Charles Goldfarb","startTime":1180.04,"endTime":1186.25,"body":"assuming shame on me. That they"},{"speaker":"Charles Goldfarb","startTime":1186.52,"endTime":1189.7,"body":"agree because they know we do"},{"speaker":"Charles Goldfarb","startTime":1186.52,"endTime":1189.7,"body":"get reimbursed for both codes. I"},{"speaker":"Charles Goldfarb","startTime":1189.7,"endTime":1191.29,"body":"don't know the answer to that"},{"speaker":"Charles Goldfarb","startTime":1189.7,"endTime":1191.29,"body":"question."},{"speaker":"Chris Dy","startTime":1191.36,"endTime":1193.43,"body":"Now I've heard through"},{"speaker":"Chris Dy","startTime":1191.36,"endTime":1193.43,"body":"the grapevine through our"},{"speaker":"Chris Dy","startTime":1193.43,"endTime":1198.26,"body":"trainees that I have converted"},{"speaker":"Chris Dy","startTime":1193.43,"endTime":1198.26,"body":"you to doing a subcutaneous"},{"speaker":"Chris Dy","startTime":1198.26,"endTime":1202.01,"body":"transposition with a The fat pad"},{"speaker":"Chris Dy","startTime":1198.26,"endTime":1202.01,"body":"flap that Mel Rosenwasser"},{"speaker":"Chris Dy","startTime":1202.01,"endTime":1207.38,"body":"originally described. When you"},{"speaker":"Chris Dy","startTime":1202.01,"endTime":1207.38,"body":"do that surgery, you can't build"},{"speaker":"Chris Dy","startTime":1207.38,"endTime":1209.0,"body":"for the flexor pronator"},{"speaker":"Chris Dy","startTime":1207.38,"endTime":1209.0,"body":"lengthening because you're not"},{"speaker":"Chris Dy","startTime":1209.0,"endTime":1210.8,"body":"doing a sub muscular. You're"},{"speaker":"Chris Dy","startTime":1209.0,"endTime":1210.8,"body":"doing a subcutaneous"},{"speaker":"Chris Dy","startTime":1210.8,"endTime":1213.92,"body":"transposition, are you just"},{"speaker":"Chris Dy","startTime":1210.8,"endTime":1213.92,"body":"64718 there? Or do you think"},{"speaker":"Chris Dy","startTime":1213.92,"endTime":1217.19,"body":"that our coders are adding"},{"speaker":"Chris Dy","startTime":1213.92,"endTime":1217.19,"body":"anything else for that pedicle"},{"speaker":"Chris Dy","startTime":1217.19,"endTime":1220.97,"body":"that up the fascial flap that"},{"speaker":"Chris Dy","startTime":1217.19,"endTime":1220.97,"body":"you're creating pocket to put"},{"speaker":"Chris Dy","startTime":1220.97,"endTime":1221.54,"body":"the nerve in."},{"speaker":"Charles Goldfarb","startTime":1221.96,"endTime":1227.0,"body":"So first of"},{"speaker":"Charles Goldfarb","startTime":1221.96,"endTime":1227.0,"body":"all, hats off to you and Mel, I"},{"speaker":"Charles Goldfarb","startTime":1227.0,"endTime":1227.9,"body":"have become a-"},{"speaker":"Chris Dy","startTime":1227.96,"endTime":1230.21,"body":"Not me, just Mel."},{"speaker":"Chris Dy","startTime":1227.96,"endTime":1230.21,"body":"That's Mel's technique, I just"},{"speaker":"Charles Goldfarb","startTime":1230.0,"endTime":1234.44,"body":"Well, you"},{"speaker":"Charles Goldfarb","startTime":1230.0,"endTime":1234.44,"body":"converted me though. Hats off,"},{"speaker":"Charles Goldfarb","startTime":1230.21,"endTime":1230.57,"body":"like it."},{"speaker":"Charles Goldfarb","startTime":1234.44,"endTime":1238.07,"body":"because I really like it. And it"},{"speaker":"Charles Goldfarb","startTime":1234.44,"endTime":1238.07,"body":"doesn't work for every patient"},{"speaker":"Charles Goldfarb","startTime":1238.07,"endTime":1241.22,"body":"and based on the volume of"},{"speaker":"Charles Goldfarb","startTime":1238.07,"endTime":1241.22,"body":"subcutaneous tissues and adipose"},{"speaker":"Charles Goldfarb","startTime":1241.25,"endTime":1245.12,"body":"cutaneous tissue. It is"},{"speaker":"Charles Goldfarb","startTime":1241.25,"endTime":1245.12,"body":"fantastic. It is a game changer"},{"speaker":"Charles Goldfarb","startTime":1245.12,"endTime":1247.94,"body":"for me. And maybe you should"},{"speaker":"Charles Goldfarb","startTime":1245.12,"endTime":1247.94,"body":"talk through it a little bit."},{"speaker":"Charles Goldfarb","startTime":1248.48,"endTime":1252.74,"body":"Just to reinforce it. I"},{"speaker":"Charles Goldfarb","startTime":1248.48,"endTime":1252.74,"body":"absolutely love it. I never love"},{"speaker":"Charles Goldfarb","startTime":1252.74,"endTime":1258.95,"body":"The Eaton flap, which is the"},{"speaker":"Charles Goldfarb","startTime":1252.74,"endTime":1258.95,"body":"dense fascia which, you know,"},{"speaker":"Charles Goldfarb","startTime":1258.95,"endTime":1262.43,"body":"was described many, many years"},{"speaker":"Charles Goldfarb","startTime":1258.95,"endTime":1262.43,"body":"ago, 50 years ago. The problem"},{"speaker":"Charles Goldfarb","startTime":1262.43,"endTime":1266.75,"body":"with the Eaton flap, in my"},{"speaker":"Charles Goldfarb","startTime":1262.43,"endTime":1266.75,"body":"humble opinion, is that it is a"},{"speaker":"Charles Goldfarb","startTime":1266.78,"endTime":1273.35,"body":"kind of rigid structure against"},{"speaker":"Charles Goldfarb","startTime":1266.78,"endTime":1273.35,"body":"a nerve. The exact positioning"},{"speaker":"Charles Goldfarb","startTime":1273.35,"endTime":1277.58,"body":"of that flap is dependent on the"},{"speaker":"Charles Goldfarb","startTime":1273.35,"endTime":1277.58,"body":"repair into the subcutaneous"},{"speaker":"Charles Goldfarb","startTime":1277.58,"endTime":1280.4,"body":"tissue. So it can theoretically"},{"speaker":"Charles Goldfarb","startTime":1277.58,"endTime":1280.4,"body":"be compressive if you're not"},{"speaker":"Charles Goldfarb","startTime":1280.4,"endTime":1284.66,"body":"careful. And it also tends to"},{"speaker":"Charles Goldfarb","startTime":1280.4,"endTime":1284.66,"body":"medialize, the nerve, and if"},{"speaker":"Charles Goldfarb","startTime":1284.66,"endTime":1287.03,"body":"you're not careful can put the"},{"speaker":"Charles Goldfarb","startTime":1284.66,"endTime":1287.03,"body":"nerve up against bone which the"},{"speaker":"Charles Goldfarb","startTime":1287.03,"endTime":1289.52,"body":"nerve doesn't like. So for those"},{"speaker":"Charles Goldfarb","startTime":1287.03,"endTime":1289.52,"body":"three reasons, I don't like it."},{"speaker":"Charles Goldfarb","startTime":1289.76,"endTime":1294.83,"body":"This adipocutaneous flap is"},{"speaker":"Charles Goldfarb","startTime":1289.76,"endTime":1294.83,"body":"fantastic. And that's a very"},{"speaker":"Charles Goldfarb","startTime":1294.83,"endTime":1298.31,"body":"long answer to your question. I"},{"speaker":"Charles Goldfarb","startTime":1294.83,"endTime":1298.31,"body":"only billed 64718. Unless you"},{"speaker":"Charles Goldfarb","startTime":1298.61,"endTime":1300.35,"body":"are going to tell me I should be"},{"speaker":"Charles Goldfarb","startTime":1298.61,"endTime":1300.35,"body":"building something else. But"},{"speaker":"Charles Goldfarb","startTime":1300.35,"endTime":1301.7,"body":"that just do a simple 64718."},{"speaker":"Chris Dy","startTime":1302.92,"endTime":1307.72,"body":"I mean, in theory, it"},{"speaker":"Chris Dy","startTime":1302.92,"endTime":1307.72,"body":"is it is pedicled. And it's"},{"speaker":"Chris Dy","startTime":1308.32,"endTime":1311.71,"body":"adipocutaneous adipofascial."},{"speaker":"Chris Dy","startTime":1308.32,"endTime":1311.71,"body":"It's how I describe it. I'll be"},{"speaker":"Chris Dy","startTime":1311.71,"endTime":1316.9,"body":"honest with you, if I list it as"},{"speaker":"Chris Dy","startTime":1311.71,"endTime":1316.9,"body":"that I have no idea whether it"},{"speaker":"Chris Dy","startTime":1316.9,"endTime":1319.84,"body":"gets coded or not. I feel so bad"},{"speaker":"Chris Dy","startTime":1316.9,"endTime":1319.84,"body":"that I don't know. Because"},{"speaker":"Chris Dy","startTime":1319.84,"endTime":1322.03,"body":"you're like, looking at your"},{"speaker":"Chris Dy","startTime":1319.84,"endTime":1322.03,"body":"codes every month. I'm like,"},{"speaker":"Chris Dy","startTime":1322.03,"endTime":1323.5,"body":"Well, I'm just like."},{"speaker":"Charles Goldfarb","startTime":1324.94,"endTime":1327.91,"body":"Well, you"},{"speaker":"Charles Goldfarb","startTime":1324.94,"endTime":1327.91,"body":"know, I mean, you we got to I"},{"speaker":"Charles Goldfarb","startTime":1327.91,"endTime":1331.51,"body":"think I listen, I hope there are"},{"speaker":"Charles Goldfarb","startTime":1327.91,"endTime":1331.51,"body":"listeners who will help us and"},{"speaker":"Charles Goldfarb","startTime":1331.57,"endTime":1334.33,"body":"tell us what they do in this"},{"speaker":"Charles Goldfarb","startTime":1331.57,"endTime":1334.33,"body":"code? And that's a great"},{"speaker":"Charles Goldfarb","startTime":1334.33,"endTime":1336.94,"body":"question. And again, I am"},{"speaker":"Charles Goldfarb","startTime":1334.33,"endTime":1336.94,"body":"grateful. Do you want to give a"},{"speaker":"Charles Goldfarb","startTime":1337.27,"endTime":1340.6,"body":"one minute description of"},{"speaker":"Charles Goldfarb","startTime":1337.27,"endTime":1340.6,"body":"exactly how you tackle this?"},{"speaker":"Charles Goldfarb","startTime":1340.6,"endTime":1342.46,"body":"Because you know, I know you"},{"speaker":"Charles Goldfarb","startTime":1340.6,"endTime":1342.46,"body":"want to talk about nerve?"},{"speaker":"Chris Dy","startTime":1342.85,"endTime":1344.68,"body":"Well, I guess the"},{"speaker":"Chris Dy","startTime":1342.85,"endTime":1344.68,"body":"first thing I'd say is I"},{"speaker":"Chris Dy","startTime":1344.68,"endTime":1347.29,"body":"probably should email our coding"},{"speaker":"Chris Dy","startTime":1344.68,"endTime":1347.29,"body":"team. And they are fantastic."},{"speaker":"Chris Dy","startTime":1347.32,"endTime":1350.05,"body":"Just asking them. That would be"},{"speaker":"Chris Dy","startTime":1347.32,"endTime":1350.05,"body":"my homework. And then there are"},{"speaker":"Chris Dy","startTime":1350.05,"endTime":1354.04,"body":"probably our private practice"},{"speaker":"Chris Dy","startTime":1350.05,"endTime":1354.04,"body":"that surgeons are like, these"},{"speaker":"Chris Dy","startTime":1354.04,"endTime":1359.17,"body":"academics are such dopes, at"},{"speaker":"Chris Dy","startTime":1354.04,"endTime":1359.17,"body":"least that Dy guy. I liked that"},{"speaker":"Chris Dy","startTime":1359.17,"endTime":1362.83,"body":"I liked that technique. You"},{"speaker":"Chris Dy","startTime":1359.17,"endTime":1362.83,"body":"know, it's there. It's based on"},{"speaker":"Chris Dy","startTime":1362.83,"endTime":1366.52,"body":"an article from Mel Rosenwasser"},{"speaker":"Chris Dy","startTime":1362.83,"endTime":1366.52,"body":"at Columbia. And instead of"},{"speaker":"Chris Dy","startTime":1366.55,"endTime":1369.13,"body":"doing whatever version of a"},{"speaker":"Chris Dy","startTime":1366.55,"endTime":1369.13,"body":"fascial sling, you're taking"},{"speaker":"Chris Dy","startTime":1369.13,"endTime":1374.44,"body":"that very nice pocket of fat"},{"speaker":"Chris Dy","startTime":1369.13,"endTime":1374.44,"body":"that sits basically right on top"},{"speaker":"Chris Dy","startTime":1374.44,"endTime":1377.47,"body":"of the intermuscular septum and"},{"speaker":"Chris Dy","startTime":1374.44,"endTime":1377.47,"body":"extends a little bit distally."},{"speaker":"Chris Dy","startTime":1377.5,"endTime":1380.5,"body":"Now you got to be careful about"},{"speaker":"Chris Dy","startTime":1377.5,"endTime":1380.5,"body":"your MADC in that area, because"},{"speaker":"Chris Dy","startTime":1380.5,"endTime":1383.59,"body":"it does tend to cross obliquely"},{"speaker":"Chris Dy","startTime":1380.5,"endTime":1383.59,"body":"right around there. But I"},{"speaker":"Chris Dy","startTime":1383.59,"endTime":1386.77,"body":"elevate as wide of a pocket of"},{"speaker":"Chris Dy","startTime":1383.59,"endTime":1386.77,"body":"that as I can. And depending on"},{"speaker":"Chris Dy","startTime":1386.77,"endTime":1389.74,"body":"the anatomy of the patient, I"},{"speaker":"Chris Dy","startTime":1386.77,"endTime":1389.74,"body":"either split that layer"},{"speaker":"Chris Dy","startTime":1389.74,"endTime":1396.04,"body":"longitudinally, like you're"},{"speaker":"Chris Dy","startTime":1389.74,"endTime":1396.04,"body":"opening, cutting into a bagel,"},{"speaker":"Chris Dy","startTime":1396.34,"endTime":1400.15,"body":"and you're opening it up and put"},{"speaker":"Chris Dy","startTime":1396.34,"endTime":1400.15,"body":"the nerve in there. Or if the"},{"speaker":"Chris Dy","startTime":1400.15,"endTime":1403.69,"body":"anatomy doesn't allow for that,"},{"speaker":"Chris Dy","startTime":1400.15,"endTime":1403.69,"body":"I will take that layer of fat,"},{"speaker":"Chris Dy","startTime":1403.84,"endTime":1408.25,"body":"and then sew it to the posterior"},{"speaker":"Chris Dy","startTime":1403.84,"endTime":1408.25,"body":"soft tissue. And after bringing"},{"speaker":"Chris Dy","startTime":1408.25,"endTime":1411.85,"body":"the nerve to the front, and"},{"speaker":"Chris Dy","startTime":1408.25,"endTime":1411.85,"body":"that's how I keep it I mean, so"},{"speaker":"Chris Dy","startTime":1411.85,"endTime":1415.36,"body":"the important part, there is"},{"speaker":"Chris Dy","startTime":1411.85,"endTime":1415.36,"body":"just a really wide wide pillow"},{"speaker":"Chris Dy","startTime":1415.39,"endTime":1419.23,"body":"for that nerve to sit in. You"},{"speaker":"Chris Dy","startTime":1415.39,"endTime":1419.23,"body":"know, it really depends on the"},{"speaker":"Chris Dy","startTime":1419.23,"endTime":1422.2,"body":"patient's anatomy, I think that"},{"speaker":"Chris Dy","startTime":1419.23,"endTime":1422.2,"body":"you know, knowing how to do an"},{"speaker":"Chris Dy","startTime":1422.2,"endTime":1426.61,"body":"Eaton sling or whatever,"},{"speaker":"Chris Dy","startTime":1422.2,"endTime":1426.61,"body":"whatever type of sling you need"},{"speaker":"Chris Dy","startTime":1426.61,"endTime":1428.83,"body":"to do is important just because"},{"speaker":"Chris Dy","startTime":1426.61,"endTime":1428.83,"body":"you never know what's going to"},{"speaker":"Chris Dy","startTime":1428.83,"endTime":1431.95,"body":"be available to you in a"},{"speaker":"Chris Dy","startTime":1428.83,"endTime":1431.95,"body":"revision or a revision of a"},{"speaker":"Chris Dy","startTime":1431.95,"endTime":1435.04,"body":"revisions. So I you know,"},{"speaker":"Chris Dy","startTime":1431.95,"endTime":1435.04,"body":"whenever we do these, I tell our"},{"speaker":"Chris Dy","startTime":1435.04,"endTime":1436.72,"body":"trainees that you got to know"},{"speaker":"Chris Dy","startTime":1435.04,"endTime":1436.72,"body":"how to do every type of"},{"speaker":"Chris Dy","startTime":1436.72,"endTime":1439.99,"body":"transposition, just because you"},{"speaker":"Chris Dy","startTime":1436.72,"endTime":1439.99,"body":"never know what you're gonna"},{"speaker":"Chris Dy","startTime":1439.99,"endTime":1442.45,"body":"have to do. Because like, for"},{"speaker":"Chris Dy","startTime":1439.99,"endTime":1442.45,"body":"example, I won't go so muscular,"},{"speaker":"Chris Dy","startTime":1442.69,"endTime":1446.35,"body":"if one of our partners or I am"},{"speaker":"Chris Dy","startTime":1442.69,"endTime":1446.35,"body":"doing a elbow contracture"},{"speaker":"Chris Dy","startTime":1446.35,"endTime":1448.81,"body":"release at the same time because"},{"speaker":"Chris Dy","startTime":1446.35,"endTime":1448.81,"body":"I don't want all that swelling"},{"speaker":"Chris Dy","startTime":1448.81,"endTime":1452.35,"body":"and inflammation from the joint"},{"speaker":"Chris Dy","startTime":1448.81,"endTime":1452.35,"body":"to be right on the nerve. And"},{"speaker":"Chris Dy","startTime":1452.35,"endTime":1455.8,"body":"then you have to tuck the nerves"},{"speaker":"Chris Dy","startTime":1452.35,"endTime":1455.8,"body":"somewhere else. So I digress. I"},{"speaker":"Chris Dy","startTime":1455.8,"endTime":1457.99,"body":"can't believe you let me talk"},{"speaker":"Chris Dy","startTime":1455.8,"endTime":1457.99,"body":"about nerve for even a little"},{"speaker":"Chris Dy","startTime":1457.99,"endTime":1461.02,"body":"bit during this coding episode."},{"speaker":"Charles Goldfarb","startTime":1464.18,"endTime":1466.79,"body":"No, it was"},{"speaker":"Charles Goldfarb","startTime":1464.18,"endTime":1466.79,"body":"self interested. So thank you."},{"speaker":"Charles Goldfarb","startTime":1466.79,"endTime":1470.99,"body":"We I maybe you can send me the"},{"speaker":"Charles Goldfarb","startTime":1466.79,"endTime":1470.99,"body":"exact article and I can put it"},{"speaker":"Charles Goldfarb","startTime":1470.99,"endTime":1471.71,"body":"in the show notes."},{"speaker":"Chris Dy","startTime":1472.1,"endTime":1474.92,"body":"Yeah, absolutely. So"},{"speaker":"Chris Dy","startTime":1472.1,"endTime":1474.92,"body":"let's get back to the ganglion"},{"speaker":"Chris Dy","startTime":1474.95,"endTime":1475.46,"body":"question."},{"speaker":"Charles Goldfarb","startTime":1476.17,"endTime":1480.19,"body":"So to me, and"},{"speaker":"Charles Goldfarb","startTime":1476.17,"endTime":1480.19,"body":"again, I hope our listeners"},{"speaker":"Charles Goldfarb","startTime":1480.19,"endTime":1484.06,"body":"aren't totally rolling their"},{"speaker":"Charles Goldfarb","startTime":1480.19,"endTime":1484.06,"body":"eyes. A ganglion excision is"},{"speaker":"Charles Goldfarb","startTime":1484.06,"endTime":1488.17,"body":"straightforward. And yes, you"},{"speaker":"Charles Goldfarb","startTime":1484.06,"endTime":1488.17,"body":"are doing a capsule ectomy and"},{"speaker":"Charles Goldfarb","startTime":1488.17,"endTime":1490.78,"body":"some might even do a post"},{"speaker":"Charles Goldfarb","startTime":1488.17,"endTime":1490.78,"body":"interosseous nerve neurectomy"},{"speaker":"Charles Goldfarb","startTime":1490.78,"endTime":1492.97,"body":"for a dorsal ganglion. I hope"},{"speaker":"Charles Goldfarb","startTime":1490.78,"endTime":1492.97,"body":"not because I don't think it"},{"speaker":"Charles Goldfarb","startTime":1492.97,"endTime":1498.4,"body":"merits that but that's"},{"speaker":"Charles Goldfarb","startTime":1492.97,"endTime":1498.4,"body":"aggressive. For a ganglion"},{"speaker":"Charles Goldfarb","startTime":1498.4,"endTime":1502.81,"body":"excision, it is a 25111 For me,"},{"speaker":"Charles Goldfarb","startTime":1498.4,"endTime":1502.81,"body":"whether it's a dorsal ganglion"},{"speaker":"Charles Goldfarb","startTime":1502.84,"endTime":1506.41,"body":"or a volar wrist ganglion, and"},{"speaker":"Charles Goldfarb","startTime":1502.84,"endTime":1506.41,"body":"that's it, nothing else. What"},{"speaker":"Charles Goldfarb","startTime":1506.0,"endTime":1508.04,"body":"Yeah, I guess"},{"speaker":"Charles Goldfarb","startTime":1506.0,"endTime":1508.04,"body":"in my naive academic brain, I"},{"speaker":"Chris Dy","startTime":1506.21,"endTime":1508.837,"body":"Now say you're doing a"},{"speaker":"Chris Dy","startTime":1506.21,"endTime":1508.837,"body":"volar? And it's because I've"},{"speaker":"Chris Dy","startTime":1506.41,"endTime":1506.74,"body":"about you?"},{"speaker":"Chris Dy","startTime":1508.52,"endTime":1517.97,"body":"think that it all evens out in"},{"speaker":"Chris Dy","startTime":1508.52,"endTime":1517.97,"body":"the end. And so some of these"},{"speaker":"Chris Dy","startTime":1508.889,"endTime":1511.877,"body":"encountered this, I've done a"},{"speaker":"Chris Dy","startTime":1508.889,"endTime":1511.877,"body":"revision or of recurrence or"},{"speaker":"Chris Dy","startTime":1511.929,"endTime":1514.608,"body":"whatever, and the cyst is"},{"speaker":"Chris Dy","startTime":1511.929,"endTime":1514.608,"body":"literally plastered on the"},{"speaker":"Chris Dy","startTime":1514.66,"endTime":1517.855,"body":"radial artery. Is that like an"},{"speaker":"Chris Dy","startTime":1514.66,"endTime":1517.855,"body":"arterial lysis code? Or what? I"},{"speaker":"Chris Dy","startTime":1517.906,"endTime":1521.152,"body":"don't know if that exists, but"},{"speaker":"Chris Dy","startTime":1517.906,"endTime":1521.152,"body":"there's quite a fair bit of work"},{"speaker":"Chris Dy","startTime":1518.3,"endTime":1538.04,"body":"will be super simple, and super"},{"speaker":"Chris Dy","startTime":1518.3,"endTime":1538.04,"body":"fast, and others will be a"},{"speaker":"Chris Dy","startTime":1521.204,"endTime":1524.192,"body":"that sometimes comes with"},{"speaker":"Chris Dy","startTime":1521.204,"endTime":1524.192,"body":"getting a cyst off the artery if"},{"speaker":"Chris Dy","startTime":1524.244,"endTime":1526.46,"body":"you choose to do that, and some"},{"speaker":"Chris Dy","startTime":1524.244,"endTime":1526.46,"body":"don't. But."},{"speaker":"Chris Dy","startTime":1538.04,"endTime":1542.42,"body":"little more challenging and will"},{"speaker":"Chris Dy","startTime":1538.04,"endTime":1542.42,"body":"require arterial lysis, so to"},{"speaker":"Chris Dy","startTime":1542.42,"endTime":1546.74,"body":"speak. There is however, as you"},{"speaker":"Chris Dy","startTime":1542.42,"endTime":1546.74,"body":"know, a separate code for a"},{"speaker":"Chris Dy","startTime":1546.74,"endTime":1553.19,"body":"recurrent or a vision ganglion"},{"speaker":"Chris Dy","startTime":1546.74,"endTime":1553.19,"body":"excision 25112. But, yeah, I,"},{"speaker":"Chris Dy","startTime":1553.22,"endTime":1557.75,"body":"for me, it's very simple one"},{"speaker":"Chris Dy","startTime":1553.22,"endTime":1557.75,"body":"code. And for carpal tunnel, you"},{"speaker":"Chris Dy","startTime":1557.75,"endTime":1561.02,"body":"know, it's one code. I think"},{"speaker":"Chris Dy","startTime":1557.75,"endTime":1561.02,"body":"other people might do some"},{"speaker":"Chris Dy","startTime":1561.02,"endTime":1563.03,"body":"different things based on this"},{"speaker":"Chris Dy","startTime":1561.02,"endTime":1563.03,"body":"article, you want to you want to"},{"speaker":"Chris Dy","startTime":1563.03,"endTime":1564.23,"body":"briefly discuss the article."},{"speaker":"Chris Dy","startTime":1564.51,"endTime":1567.6,"body":"Yeah, sure. I mean, so"},{"speaker":"Chris Dy","startTime":1564.51,"endTime":1567.6,"body":"this, this article is, let's"},{"speaker":"Chris Dy","startTime":1567.6,"endTime":1572.22,"body":"pull it up here is in JHSGO, and"},{"speaker":"Chris Dy","startTime":1567.6,"endTime":1572.22,"body":"it was last year. It's, it's"},{"speaker":"Chris Dy","startTime":1572.22,"endTime":1575.64,"body":"from the group at NYU. Steve"},{"speaker":"Chris Dy","startTime":1572.22,"endTime":1575.64,"body":"Glickel, the senior author."},{"speaker":"Chris Dy","startTime":1575.64,"endTime":1578.85,"body":"first author is Ryan Coyle. So"},{"speaker":"Chris Dy","startTime":1575.64,"endTime":1578.85,"body":"thank you, Ryan, and Steve, for"},{"speaker":"Chris Dy","startTime":1578.85,"endTime":1581.64,"body":"bringing us this article. It's"},{"speaker":"Chris Dy","startTime":1578.85,"endTime":1581.64,"body":"called coding practices in hand"},{"speaker":"Chris Dy","startTime":1581.64,"endTime":1585.0,"body":"surgery and their relationship"},{"speaker":"Chris Dy","startTime":1581.64,"endTime":1585.0,"body":"to surgeon compensation. So sent"},{"speaker":"Chris Dy","startTime":1585.0,"endTime":1589.11,"body":"out a survey to hand society"},{"speaker":"Chris Dy","startTime":1585.0,"endTime":1589.11,"body":"members and they got out of over"},{"speaker":"Chris Dy","startTime":1589.11,"endTime":1592.32,"body":"4000 invitations, they got a 9%"},{"speaker":"Chris Dy","startTime":1589.11,"endTime":1592.32,"body":"response rate, which is actually"},{"speaker":"Chris Dy","startTime":1592.32,"endTime":1596.31,"body":"pretty reasonable. And then"},{"speaker":"Chris Dy","startTime":1592.32,"endTime":1596.31,"body":"they, they asked them how they"},{"speaker":"Chris Dy","startTime":1596.31,"endTime":1600.72,"body":"would code a thumb CMC surgery,"},{"speaker":"Chris Dy","startTime":1596.31,"endTime":1600.72,"body":"trapeziectomy and a distal"},{"speaker":"Chris Dy","startTime":1600.72,"endTime":1604.68,"body":"radius case. And then they"},{"speaker":"Chris Dy","startTime":1600.72,"endTime":1604.68,"body":"looked at how the surgeons were"},{"speaker":"Chris Dy","startTime":1604.68,"endTime":1609.12,"body":"compensated and whether they did"},{"speaker":"Chris Dy","startTime":1604.68,"endTime":1609.12,"body":"their own coding, etc. And it"},{"speaker":"Chris Dy","startTime":1609.12,"endTime":1612.81,"body":"made a difference. You know, so"},{"speaker":"Chris Dy","startTime":1609.12,"endTime":1612.81,"body":"if you are a collections based"},{"speaker":"Chris Dy","startTime":1613.08,"endTime":1617.16,"body":"surgeon or an RVU based surgeon,"},{"speaker":"Chris Dy","startTime":1613.08,"endTime":1617.16,"body":"you definitely code differently"},{"speaker":"Chris Dy","startTime":1617.19,"endTime":1620.28,"body":"than if you were, if you're"},{"speaker":"Chris Dy","startTime":1617.19,"endTime":1620.28,"body":"salary. And then I guess that's"},{"speaker":"Chris Dy","startTime":1620.28,"endTime":1624.24,"body":"not surprising. You know, I"},{"speaker":"Chris Dy","startTime":1620.28,"endTime":1624.24,"body":"think we kind of talked about"},{"speaker":"Charles Goldfarb","startTime":1624.0,"endTime":1629.13,"body":"Yeah, yeah, I"},{"speaker":"Charles Goldfarb","startTime":1624.0,"endTime":1629.13,"body":"don't think it's surprise. It's,"},{"speaker":"Charles Goldfarb","startTime":1624.24,"endTime":1624.99,"body":"that early on."},{"speaker":"Charles Goldfarb","startTime":1629.13,"endTime":1633.81,"body":"um, it's not appropriate. This"},{"speaker":"Charles Goldfarb","startTime":1629.13,"endTime":1633.81,"body":"should be different. But it's,"},{"speaker":"Charles Goldfarb","startTime":1634.71,"endTime":1638.76,"body":"it's not surprising. Let's go"},{"speaker":"Charles Goldfarb","startTime":1634.71,"endTime":1638.76,"body":"through these. So the first was"},{"speaker":"Charles Goldfarb","startTime":1639.06,"endTime":1644.1,"body":"carpal tunnel release. All"},{"speaker":"Charles Goldfarb","startTime":1639.06,"endTime":1644.1,"body":"right, yeah. And the CPT code"},{"speaker":"Charles Goldfarb","startTime":1644.1,"endTime":1648.99,"body":"that the vast majority of people"},{"speaker":"Charles Goldfarb","startTime":1644.1,"endTime":1648.99,"body":"provided was 64721, which I"},{"speaker":"Charles Goldfarb","startTime":1648.99,"endTime":1655.62,"body":"think you and I would totally"},{"speaker":"Charles Goldfarb","startTime":1648.99,"endTime":1655.62,"body":"agree upon. But there are others"},{"speaker":"Charles Goldfarb","startTime":1655.62,"endTime":1661.44,"body":"included, some of which surprise"},{"speaker":"Charles Goldfarb","startTime":1655.62,"endTime":1661.44,"body":"me synovectomy was given as one"},{"speaker":"Charles Goldfarb","startTime":1661.44,"endTime":1664.38,"body":"that might be included, I was"},{"speaker":"Charles Goldfarb","startTime":1661.44,"endTime":1664.38,"body":"always taught that if you do"},{"speaker":"Charles Goldfarb","startTime":1664.38,"endTime":1666.96,"body":"perform a synovectomy, that"},{"speaker":"Charles Goldfarb","startTime":1664.38,"endTime":1666.96,"body":"supersedes the carpal tunnel,"},{"speaker":"Charles Goldfarb","startTime":1667.02,"endTime":1672.84,"body":"and you don't build both"},{"speaker":"Charles Goldfarb","startTime":1667.02,"endTime":1672.84,"body":"internal neurolysis. Gosh, I"},{"speaker":"Charles Goldfarb","startTime":1672.84,"endTime":1675.6,"body":"didn't think anyone was doing"},{"speaker":"Charles Goldfarb","startTime":1672.84,"endTime":1675.6,"body":"that anymore, based on McKinnon"},{"speaker":"Charles Goldfarb","startTime":1675.6,"endTime":1677.76,"body":"and Gelberman separate work"},{"speaker":"Charles Goldfarb","startTime":1675.6,"endTime":1677.76,"body":"showing that that wasn't"},{"speaker":"Charles Goldfarb","startTime":1677.76,"endTime":1681.54,"body":"necessary. So people add on"},{"speaker":"Charles Goldfarb","startTime":1677.76,"endTime":1681.54,"body":"different codes. And I just have"},{"speaker":"Charles Goldfarb","startTime":1681.54,"endTime":1682.2,"body":"never done that."},{"speaker":"Chris Dy","startTime":1682.0,"endTime":1685.66,"body":"That's very clear"},{"speaker":"Chris Dy","startTime":1682.0,"endTime":1685.66,"body":"anybody listening as a trainee,"},{"speaker":"Chris Dy","startTime":1685.69,"endTime":1688.66,"body":"you should not be doing an"},{"speaker":"Chris Dy","startTime":1685.69,"endTime":1688.66,"body":"interim analysis of the median"},{"speaker":"Chris Dy","startTime":1688.66,"endTime":1694.99,"body":"nerve if you're doing a primary"},{"speaker":"Chris Dy","startTime":1688.66,"endTime":1694.99,"body":"carpal tunnel release. So maybe"},{"speaker":"Chris Dy","startTime":1694.99,"endTime":1697.81,"body":"there are some situations like a"},{"speaker":"Chris Dy","startTime":1694.99,"endTime":1697.81,"body":"revision or something like that,"},{"speaker":"Chris Dy","startTime":1697.81,"endTime":1700.87,"body":"where you actually do need to do"},{"speaker":"Chris Dy","startTime":1697.81,"endTime":1700.87,"body":"an internal neurolysis, but not"},{"speaker":"Chris Dy","startTime":1700.9,"endTime":1704.77,"body":"in a primary carpal tunnel"},{"speaker":"Chris Dy","startTime":1700.9,"endTime":1704.77,"body":"release. I was told always that"},{"speaker":"Chris Dy","startTime":1704.83,"endTime":1708.1,"body":"I do a lot of local. And I was"},{"speaker":"Chris Dy","startTime":1704.83,"endTime":1708.1,"body":"told you're not allowed to bill"},{"speaker":"Chris Dy","startTime":1708.1,"endTime":1711.07,"body":"for that local. But it looks"},{"speaker":"Chris Dy","startTime":1708.1,"endTime":1711.07,"body":"like there are some people here"},{"speaker":"Chris Dy","startTime":1711.07,"endTime":1714.37,"body":"that are billing for the local"},{"speaker":"Chris Dy","startTime":1711.07,"endTime":1714.37,"body":"anesthesia that's provided"},{"speaker":"Chris Dy","startTime":1714.37,"endTime":1716.68,"body":"either I don't know whether that"},{"speaker":"Chris Dy","startTime":1714.37,"endTime":1716.68,"body":"means that they're doing it as"},{"speaker":"Chris Dy","startTime":1716.68,"endTime":1718.66,"body":"part of their will on like"},{"speaker":"Chris Dy","startTime":1716.68,"endTime":1718.66,"body":"beforehand, or whether they're"},{"speaker":"Chris Dy","startTime":1718.66,"endTime":1723.31,"body":"doing that as part of maybe like"},{"speaker":"Chris Dy","startTime":1718.66,"endTime":1723.31,"body":"a post op and administration of"},{"speaker":"Chris Dy","startTime":1723.31,"endTime":1723.85,"body":"anesthetic."},{"speaker":"Charles Goldfarb","startTime":1724.24,"endTime":1726.22,"body":"My education"},{"speaker":"Charles Goldfarb","startTime":1724.24,"endTime":1726.22,"body":"was the same as yours that we"},{"speaker":"Charles Goldfarb","startTime":1726.22,"endTime":1729.7,"body":"are not, you know, the"},{"speaker":"Charles Goldfarb","startTime":1726.22,"endTime":1729.7,"body":"anesthesia is incorporated as"},{"speaker":"Charles Goldfarb","startTime":1729.7,"endTime":1733.18,"body":"part of the of the code. Getting"},{"speaker":"Charles Goldfarb","startTime":1729.7,"endTime":1733.18,"body":"back to that global services."},{"speaker":"Charles Goldfarb","startTime":1733.21,"endTime":1737.53,"body":"64721 includes anesthesia, pre"},{"speaker":"Charles Goldfarb","startTime":1733.21,"endTime":1737.53,"body":"and post I think, again, correct"},{"speaker":"Charles Goldfarb","startTime":1737.53,"endTime":1739.51,"body":"us if we're wrong. Interesting."},{"speaker":"Chris Dy","startTime":1740.11,"endTime":1742.27,"body":"Yeah, yeah. So that"},{"speaker":"Chris Dy","startTime":1740.11,"endTime":1742.27,"body":"the next one that they looked at"},{"speaker":"Chris Dy","startTime":1742.27,"endTime":1745.93,"body":"was distal, radius, fracture"},{"speaker":"Chris Dy","startTime":1742.27,"endTime":1745.93,"body":"fixation. And there were all"},{"speaker":"Chris Dy","startTime":1745.93,"endTime":1747.97,"body":"sorts of codes that were"},{"speaker":"Chris Dy","startTime":1745.93,"endTime":1747.97,"body":"included. I mean, most people"},{"speaker":"Chris Dy","startTime":1747.97,"endTime":1752.2,"body":"went with 25607, you know, with"},{"speaker":"Chris Dy","startTime":1747.97,"endTime":1752.2,"body":"which is, you know, treatment of"},{"speaker":"Chris Dy","startTime":1752.23,"endTime":1756.79,"body":"an extra articular distal radius"},{"speaker":"Chris Dy","startTime":1752.23,"endTime":1756.79,"body":"fracture. I think that there are"},{"speaker":"Chris Dy","startTime":1756.79,"endTime":1760.12,"body":"many ways to justify intra"},{"speaker":"Chris Dy","startTime":1756.79,"endTime":1760.12,"body":"articular involvement, based on"},{"speaker":"Chris Dy","startTime":1760.12,"endTime":1763.45,"body":"whether it's, many of these"},{"speaker":"Chris Dy","startTime":1760.12,"endTime":1763.45,"body":"fractures are really metaphyseal"},{"speaker":"Chris Dy","startTime":1763.45,"endTime":1766.24,"body":"base, but do extend into the"},{"speaker":"Chris Dy","startTime":1763.45,"endTime":1766.24,"body":"radiocarpal joint, I've seen"},{"speaker":"Chris Dy","startTime":1766.24,"endTime":1770.74,"body":"some people justify extension"},{"speaker":"Chris Dy","startTime":1766.24,"endTime":1770.74,"body":"into the sigmoid notch as an"},{"speaker":"Chris Dy","startTime":1770.74,"endTime":1773.47,"body":"intra articular fracture. So I"},{"speaker":"Chris Dy","startTime":1770.74,"endTime":1773.47,"body":"think maybe there's some room"},{"speaker":"Chris Dy","startTime":1773.47,"endTime":1776.83,"body":"for interpretation there."},{"speaker":"Chris Dy","startTime":1773.47,"endTime":1776.83,"body":"Another code that was often"},{"speaker":"Chris Dy","startTime":1776.83,"endTime":1780.91,"body":"billed and I want your thoughts"},{"speaker":"Chris Dy","startTime":1776.83,"endTime":1780.91,"body":"on this was the fluoroscopy. You"},{"speaker":"Chris Dy","startTime":1780.91,"endTime":1783.61,"body":"know, I know that that's one"},{"speaker":"Chris Dy","startTime":1780.91,"endTime":1783.61,"body":"point that you are feel strongly"},{"speaker":"Chris Dy","startTime":1783.61,"endTime":1788.2,"body":"about. And then the other"},{"speaker":"Chris Dy","startTime":1783.61,"endTime":1788.2,"body":"application of cast, which I"},{"speaker":"Chris Dy","startTime":1788.2,"endTime":1789.01,"body":"think is interesting."},{"speaker":"Charles Goldfarb","startTime":1789.48,"endTime":1791.76,"body":"Yeah. So"},{"speaker":"Charles Goldfarb","startTime":1789.48,"endTime":1791.76,"body":"application of cast is not is"},{"speaker":"Charles Goldfarb","startTime":1791.76,"endTime":1794.01,"body":"not something we should be doing"},{"speaker":"Charles Goldfarb","startTime":1791.76,"endTime":1794.01,"body":"for that's part of the global"},{"speaker":"Charles Goldfarb","startTime":1794.01,"endTime":1796.86,"body":"services. And then the other one"},{"speaker":"Charles Goldfarb","startTime":1794.01,"endTime":1796.86,"body":"I think is release of the"},{"speaker":"Charles Goldfarb","startTime":1796.86,"endTime":1801.78,"body":"brachioradialis is incorporates"},{"speaker":"Charles Goldfarb","startTime":1796.86,"endTime":1801.78,"body":"tenotomy So BR release again, to"},{"speaker":"Charles Goldfarb","startTime":1801.78,"endTime":1806.82,"body":"me, I that that is, I guess, in"},{"speaker":"Charles Goldfarb","startTime":1801.78,"endTime":1806.82,"body":"my mind less egregious than"},{"speaker":"Charles Goldfarb","startTime":1806.85,"endTime":1809.13,"body":"billing for a cast application,"},{"speaker":"Charles Goldfarb","startTime":1806.85,"endTime":1809.13,"body":"but it's just part of the"},{"speaker":"Charles Goldfarb","startTime":1809.13,"endTime":1813.3,"body":"procedure, it also takes 10"},{"speaker":"Charles Goldfarb","startTime":1809.13,"endTime":1813.3,"body":"seconds. Now, someone who sees"},{"speaker":"Charles Goldfarb","startTime":1813.3,"endTime":1817.23,"body":"this process differently will"},{"speaker":"Charles Goldfarb","startTime":1813.3,"endTime":1817.23,"body":"say, we are doing this, we"},{"speaker":"Charles Goldfarb","startTime":1817.23,"endTime":1819.78,"body":"should be compensated for it."},{"speaker":"Charles Goldfarb","startTime":1817.23,"endTime":1819.78,"body":"And that's just a difference in"},{"speaker":"Charles Goldfarb","startTime":1819.78,"endTime":1825.6,"body":"philosophy. However, I think if"},{"speaker":"Charles Goldfarb","startTime":1819.78,"endTime":1825.6,"body":"you use a mini C-arm, then it is"},{"speaker":"Charles Goldfarb","startTime":1825.63,"endTime":1831.9,"body":"very appropriate to bill for"},{"speaker":"Charles Goldfarb","startTime":1825.63,"endTime":1831.9,"body":"that and collect for it. So I"},{"speaker":"Charles Goldfarb","startTime":1831.9,"endTime":1834.96,"body":"don't, we don't own the mini"},{"speaker":"Charles Goldfarb","startTime":1831.9,"endTime":1834.96,"body":"C-arm machine, but we can bill"},{"speaker":"Charles Goldfarb","startTime":1834.96,"endTime":1839.28,"body":"for the professional fee. And"},{"speaker":"Charles Goldfarb","startTime":1834.96,"endTime":1839.28,"body":"actually, our radiologists agree"},{"speaker":"Charles Goldfarb","startTime":1839.28,"endTime":1842.79,"body":"with that, even if they review"},{"speaker":"Charles Goldfarb","startTime":1839.28,"endTime":1842.79,"body":"them later, because this is in"},{"speaker":"Charles Goldfarb","startTime":1842.79,"endTime":1846.75,"body":"that it would be inappropriate"},{"speaker":"Charles Goldfarb","startTime":1842.79,"endTime":1846.75,"body":"for me to consider a radiology"},{"speaker":"Charles Goldfarb","startTime":1846.75,"endTime":1851.79,"body":"partner 12 hours later reviewing"},{"speaker":"Charles Goldfarb","startTime":1846.75,"endTime":1851.79,"body":"and billing for an inter"},{"speaker":"Charles Goldfarb","startTime":1851.79,"endTime":1856.11,"body":"operative, you know, C-arm"},{"speaker":"Charles Goldfarb","startTime":1851.79,"endTime":1856.11,"body":"assessment. So I think is very"},{"speaker":"Charles Goldfarb","startTime":1856.11,"endTime":1858.39,"body":"appropriate there. You have"},{"speaker":"Charles Goldfarb","startTime":1856.11,"endTime":1858.39,"body":"their rules and regulations and"},{"speaker":"Charles Goldfarb","startTime":1858.39,"endTime":1861.03,"body":"how you do it, you have to"},{"speaker":"Charles Goldfarb","startTime":1858.39,"endTime":1861.03,"body":"dictate dictate a separate note"},{"speaker":"Charles Goldfarb","startTime":1861.06,"endTime":1863.19,"body":"talking about the views you"},{"speaker":"Charles Goldfarb","startTime":1861.06,"endTime":1863.19,"body":"obtained and talk about what you"},{"speaker":"Charles Goldfarb","startTime":1863.19,"endTime":1866.01,"body":"saw, but I do feel strongly that"},{"speaker":"Charles Goldfarb","startTime":1863.19,"endTime":1866.01,"body":"that is very appropriate."},{"speaker":"Chris Dy","startTime":1867.09,"endTime":1870.24,"body":"Yeah, I mean, I, I"},{"speaker":"Chris Dy","startTime":1867.09,"endTime":1870.24,"body":"dictate a separate note for her"},{"speaker":"Chris Dy","startTime":1870.3,"endTime":1872.7,"body":"a portion of the of the"},{"speaker":"Chris Dy","startTime":1870.3,"endTime":1872.7,"body":"operative note for the"},{"speaker":"Chris Dy","startTime":1872.79,"endTime":1875.91,"body":"fluoroscopy interpretation. And"},{"speaker":"Chris Dy","startTime":1872.79,"endTime":1875.91,"body":"then in the clinic, I'll also"},{"speaker":"Chris Dy","startTime":1875.94,"endTime":1879.03,"body":"put a separate note in for the"},{"speaker":"Chris Dy","startTime":1875.94,"endTime":1879.03,"body":"mini C-arms. I mean, I don't"},{"speaker":"Chris Dy","startTime":1879.03,"endTime":1882.9,"body":"know, it's obviously not a ton"},{"speaker":"Chris Dy","startTime":1879.03,"endTime":1882.9,"body":"from an RVU perspective, but as"},{"speaker":"Chris Dy","startTime":1882.9,"endTime":1884.52,"body":"you've mentioned, it adds up"},{"speaker":"Chris Dy","startTime":1882.9,"endTime":1884.52,"body":"over time."},{"speaker":"Charles Goldfarb","startTime":1885.27,"endTime":1887.7,"body":"It does, it"},{"speaker":"Charles Goldfarb","startTime":1885.27,"endTime":1887.7,"body":"does. Yeah, it's usually 25-35"},{"speaker":"Charles Goldfarb","startTime":1887.7,"endTime":1891.15,"body":"bucks or something. But given"},{"speaker":"Charles Goldfarb","startTime":1887.7,"endTime":1891.15,"body":"our hand surgeon professional is"},{"speaker":"Charles Goldfarb","startTime":1891.15,"endTime":1892.29,"body":"something we do regularly."},{"speaker":"Chris Dy","startTime":1893.61,"endTime":1895.56,"body":"So did you want to"},{"speaker":"Chris Dy","startTime":1893.61,"endTime":1895.56,"body":"talk about either the"},{"speaker":"Chris Dy","startTime":1895.59,"endTime":1899.07,"body":"trapeziectomy one or the"},{"speaker":"Chris Dy","startTime":1895.59,"endTime":1899.07,"body":"scaphoid case, before we wrap"},{"speaker":"Chris Dy","startTime":1899.07,"endTime":1899.34,"body":"up?"},{"speaker":"Charles Goldfarb","startTime":1899.79,"endTime":1901.53,"body":"This scaphoid,"},{"speaker":"Charles Goldfarb","startTime":1899.79,"endTime":1901.53,"body":"I think it'd be super easy. I"},{"speaker":"Charles Goldfarb","startTime":1901.53,"endTime":1905.7,"body":"think most of us for scaphoid"},{"speaker":"Charles Goldfarb","startTime":1901.53,"endTime":1905.7,"body":"nonunion will bill 25440 Which"},{"speaker":"Charles Goldfarb","startTime":1905.7,"endTime":1909.18,"body":"does incorporate bone grafting."},{"speaker":"Charles Goldfarb","startTime":1905.7,"endTime":1909.18,"body":"So again, it's one of those"},{"speaker":"Charles Goldfarb","startTime":1909.18,"endTime":1911.58,"body":"where I'm a little surprised"},{"speaker":"Charles Goldfarb","startTime":1909.18,"endTime":1911.58,"body":"there are other codes being"},{"speaker":"Charles Goldfarb","startTime":1911.58,"endTime":1912.18,"body":"included."},{"speaker":"Chris Dy","startTime":1912.93,"endTime":1914.25,"body":"Like a bone graft"},{"speaker":"Chris Dy","startTime":1912.93,"endTime":1914.25,"body":"code?"},{"speaker":"Charles Goldfarb","startTime":1914.82,"endTime":1917.19,"body":"Like a bone"},{"speaker":"Charles Goldfarb","startTime":1914.82,"endTime":1917.19,"body":"graft code. The other one you"},{"speaker":"Charles Goldfarb","startTime":1917.19,"endTime":1921.87,"body":"can't you can't include not that"},{"speaker":"Charles Goldfarb","startTime":1917.19,"endTime":1921.87,"body":"was done here is if it's a non"},{"speaker":"Charles Goldfarb","startTime":1921.87,"endTime":1926.7,"body":"union, and you take out a screw,"},{"speaker":"Charles Goldfarb","startTime":1921.87,"endTime":1926.7,"body":"and then you're revising"},{"speaker":"Charles Goldfarb","startTime":1926.7,"endTime":1929.07,"body":"fixation with bone graft. You"},{"speaker":"Charles Goldfarb","startTime":1926.7,"endTime":1929.07,"body":"can't bill for that screw"},{"speaker":"Charles Goldfarb","startTime":1929.07,"endTime":1932.58,"body":"removal, but you can't bill for"},{"speaker":"Charles Goldfarb","startTime":1929.07,"endTime":1932.58,"body":"bone graft here. The interesting"},{"speaker":"Charles Goldfarb","startTime":1932.58,"endTime":1936.84,"body":"one, as you mentioned, is that"},{"speaker":"Charles Goldfarb","startTime":1932.58,"endTime":1936.84,"body":"trapeziectomy. And that in we in"},{"speaker":"Charles Goldfarb","startTime":1936.84,"endTime":1940.44,"body":"the hand society actually knows"},{"speaker":"Charles Goldfarb","startTime":1936.84,"endTime":1940.44,"body":"this, we're all over the map on"},{"speaker":"Charles Goldfarb","startTime":1940.44,"endTime":1943.5,"body":"how we bill and that's what this"},{"speaker":"Charles Goldfarb","startTime":1940.44,"endTime":1943.5,"body":"paper does demonstrate. And you"},{"speaker":"Charles Goldfarb","startTime":1943.5,"endTime":1947.61,"body":"and I have had to modify how we"},{"speaker":"Charles Goldfarb","startTime":1943.5,"endTime":1947.61,"body":"think about it. Because we are"},{"speaker":"Charles Goldfarb","startTime":1948.57,"endTime":1954.18,"body":"generally using a suspension"},{"speaker":"Charles Goldfarb","startTime":1948.57,"endTime":1954.18,"body":"plasty with a internal brace or"},{"speaker":"Charles Goldfarb","startTime":1954.18,"endTime":1958.44,"body":"wherever you want to call it."},{"speaker":"Charles Goldfarb","startTime":1954.18,"endTime":1958.44,"body":"And so previously, I used and"},{"speaker":"Charles Goldfarb","startTime":1958.44,"endTime":1962.55,"body":"fcr kind of the classic"},{"speaker":"Charles Goldfarb","startTime":1958.44,"endTime":1962.55,"body":"procedure, Burton and Pellegrini"},{"speaker":"Charles Goldfarb","startTime":1962.55,"endTime":1967.59,"body":"style, and I used fcr. And I did"},{"speaker":"Charles Goldfarb","startTime":1962.55,"endTime":1967.59,"body":"bill for that, that 25310. But"},{"speaker":"Charles Goldfarb","startTime":1967.59,"endTime":1971.4,"body":"now I you know, I am doing"},{"speaker":"Charles Goldfarb","startTime":1967.59,"endTime":1971.4,"body":"something that I think is better"},{"speaker":"Charles Goldfarb","startTime":1971.52,"endTime":1975.93,"body":"and more patient friendly. And"},{"speaker":"Charles Goldfarb","startTime":1971.52,"endTime":1975.93,"body":"I'm billing less, I'm doing less"},{"speaker":"Charles Goldfarb","startTime":1975.93,"endTime":1980.16,"body":"work, and I'm billing less and"},{"speaker":"Charles Goldfarb","startTime":1975.93,"endTime":1980.16,"body":"so I just bill 25447 How do you"},{"speaker":"Chris Dy","startTime":1980.0,"endTime":1983.99,"body":"I think the same way."},{"speaker":"Chris Dy","startTime":1980.0,"endTime":1983.99,"body":"I mean, I think that, yes, we're"},{"speaker":"Chris Dy","startTime":1980.16,"endTime":1980.76,"body":"think about it?"},{"speaker":"Chris Dy","startTime":1983.99,"endTime":1986.36,"body":"all over the map on coding,"},{"speaker":"Chris Dy","startTime":1983.99,"endTime":1986.36,"body":"because we're all over the map"},{"speaker":"Chris Dy","startTime":1986.36,"endTime":1990.92,"body":"on what to do. There's no right"},{"speaker":"Chris Dy","startTime":1986.36,"endTime":1990.92,"body":"treatment for this. And yes, we"},{"speaker":"Chris Dy","startTime":1990.92,"endTime":1993.44,"body":"probably should, you know, be"},{"speaker":"Chris Dy","startTime":1990.92,"endTime":1993.44,"body":"billing less because we're doing"},{"speaker":"Chris Dy","startTime":1993.44,"endTime":1995.99,"body":"less work. And this is supposed"},{"speaker":"Chris Dy","startTime":1993.44,"endTime":1995.99,"body":"to be you know, relative value"},{"speaker":"Chris Dy","startTime":1995.99,"endTime":1997.97,"body":"and it's at work. So yeah, I"},{"speaker":"Chris Dy","startTime":1995.99,"endTime":1997.97,"body":"think it's fair"},{"speaker":"Charles Goldfarb","startTime":1998.63,"endTime":2001.06,"body":"Excellent."},{"speaker":"Charles Goldfarb","startTime":1998.63,"endTime":2001.06,"body":"Excellent. Well, I this is fun."},{"speaker":"Charles Goldfarb","startTime":2001.21,"endTime":2005.77,"body":"As you know, I like this and I"},{"speaker":"Charles Goldfarb","startTime":2001.21,"endTime":2005.77,"body":"like listener questions and I"},{"speaker":"Charles Goldfarb","startTime":2005.77,"endTime":2008.95,"body":"hope and think we're gonna get"},{"speaker":"Charles Goldfarb","startTime":2005.77,"endTime":2008.95,"body":"some feedback on this one"},{"speaker":"Charles Goldfarb","startTime":2008.95,"endTime":2012.01,"body":"because this will resonate with"},{"speaker":"Charles Goldfarb","startTime":2008.95,"endTime":2012.01,"body":"many so fun topic."},{"speaker":"Chris Dy","startTime":2012.34,"endTime":2015.97,"body":"Yeah, please tell us"},{"speaker":"Chris Dy","startTime":2012.34,"endTime":2015.97,"body":"how we can code better. Maybe"},{"speaker":"Chris Dy","startTime":2015.97,"endTime":2017.14,"body":"I'll start paying more"},{"speaker":"Chris Dy","startTime":2015.97,"endTime":2017.14,"body":"attention."},{"speaker":"Charles Goldfarb","startTime":2017.71,"endTime":2019.81,"body":"Yeah, what's"},{"speaker":"Charles Goldfarb","startTime":2017.71,"endTime":2019.81,"body":"your I'm going to take your role"},{"speaker":"Charles Goldfarb","startTime":2019.81,"endTime":2021.31,"body":"here. What's your win for the"},{"speaker":"Charles Goldfarb","startTime":2019.81,"endTime":2021.31,"body":"week?"},{"speaker":"Chris Dy","startTime":2022.78,"endTime":2026.53,"body":"My win for the week is"},{"speaker":"Chris Dy","startTime":2022.78,"endTime":2026.53,"body":"opening get, actually the kids"},{"speaker":"Chris Dy","startTime":2026.53,"endTime":2029.77,"body":"getting in the pool and me"},{"speaker":"Chris Dy","startTime":2026.53,"endTime":2029.77,"body":"paying way too much to heat the"},{"speaker":"Chris Dy","startTime":2029.77,"endTime":2033.07,"body":"pool in this weather. But uh,"},{"speaker":"Chris Dy","startTime":2029.77,"endTime":2033.07,"body":"yes, the pool is sitting a"},{"speaker":"Chris Dy","startTime":2033.07,"endTime":2036.01,"body":"lovely it'll be a lovely 80"},{"speaker":"Chris Dy","startTime":2033.07,"endTime":2036.01,"body":"degrees by the end of the"},{"speaker":"Chris Dy","startTime":2036.04,"endTime":2036.64,"body":"afternoon."},{"speaker":"Charles Goldfarb","startTime":2037.69,"endTime":2041.77,"body":"My win is"},{"speaker":"Charles Goldfarb","startTime":2037.69,"endTime":2041.77,"body":"vacation. You know, it is"},{"speaker":"Charles Goldfarb","startTime":2041.8,"endTime":2047.95,"body":"indescribable and mandatory. And"},{"speaker":"Charles Goldfarb","startTime":2041.8,"endTime":2047.95,"body":"it's felt like a long time"},{"speaker":"Charles Goldfarb","startTime":2047.95,"endTime":2050.23,"body":"coming. And I was really good."},{"speaker":"Charles Goldfarb","startTime":2047.95,"endTime":2050.23,"body":"This vacation. First of all, I"},{"speaker":"Charles Goldfarb","startTime":2050.23,"endTime":2053.74,"body":"was grateful that my entire"},{"speaker":"Charles Goldfarb","startTime":2050.23,"endTime":2053.74,"body":"family could could join us. And"},{"speaker":"Charles Goldfarb","startTime":2053.77,"endTime":2057.28,"body":"I really didn't open the"},{"speaker":"Charles Goldfarb","startTime":2053.77,"endTime":2057.28,"body":"computer much. And it was great."},{"speaker":"Chris Dy","startTime":2057.73,"endTime":2060.25,"body":"I'm sure you snuck"},{"speaker":"Chris Dy","startTime":2057.73,"endTime":2060.25,"body":"away at 4:30am to check your"},{"speaker":"Chris Dy","startTime":2060.25,"endTime":2060.58,"body":"email."},{"speaker":"Charles Goldfarb","startTime":2061.81,"endTime":2062.62,"body":"Once in a"},{"speaker":"Charles Goldfarb","startTime":2061.81,"endTime":2062.62,"body":"while."},{"speaker":"Chris Dy","startTime":2063.19,"endTime":2065.02,"body":"If they don't know"},{"speaker":"Chris Dy","startTime":2063.19,"endTime":2065.02,"body":"about it, it didn't happen."},{"speaker":"Chris Dy","startTime":2065.02,"endTime":2069.67,"body":"Right. Have a good rest of your"},{"speaker":"Chris Dy","startTime":2065.02,"endTime":2069.67,"body":"day?"},{"speaker":"Charles Goldfarb","startTime":2069.76,"endTime":2073.0,"body":"Yeah, you do"},{"speaker":"Charles Goldfarb","startTime":2069.76,"endTime":2073.0,"body":"the same. Take care. Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2073.03,"endTime":2074.86,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2073.03,"endTime":2074.86,"body":"real soon."},{"speaker":"Chris Dy","startTime":2075.13,"endTime":2077.65,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2075.13,"endTime":2077.65,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2077.8,"endTime":2080.05,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2077.8,"endTime":2080.05,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2080.38,"endTime":2083.35,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2080.38,"endTime":2083.35,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2083.389,"endTime":2086.869,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2083.389,"endTime":2086.869,"body":"spelled dy. And if you'd like to"},{"speaker":"Chris Dy","startTime":2086.869,"endTime":2090.289,"body":"email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2086.869,"endTime":2090.289,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2091.219,"endTime":2093.349,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2091.219,"endTime":2093.349,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2093.349,"endTime":2094.429,"body":"get your podcasts."},{"speaker":"Chris Dy","startTime":2094.489,"endTime":2096.709,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":2094.489,"endTime":2096.709,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2096.709,"endTime":2097.099,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2097.49,"endTime":2099.77,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2097.49,"endTime":2099.77,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2099.77,"endTime":2103.76,"body":"music and remember keep the"},{"speaker":"Charles Goldfarb","startTime":2099.77,"endTime":2103.76,"body":"upper hand come back next time."}]}