ED Coding and Reimbursement Alert

Question: A patient presents to the ED after crushing the tip of his right thumb during a rugby match. Notes indicate that the ED physician used trephination to evacuate a subungual hematoma. I am somewhat new to ED coding, and am having trouble with these encounter notes. How should I code this procedure? Ohio Subscriber Answer: A subungual hematoma occurs when blood (or other purulent fluid) collects between the nailbed and the fingernail. This injury causes painful pressure to build in the affected digit, which the ED physician can relieve through trephination (burring of a small hole into the nail) with an electrocautery tool. When your physician evacuates a subungual hematoma, report 11740 (Evacuation of subungual hematoma). Also, append ICD-9 codes 923.3 (Contusion of upper limb; finger) to represent the patient's injury, and E917.0 (Striking against or struck accidentally by objects or persons; in sports without subsequent fall) to represent the cause of the patient's injury. Bundle warning: Do not report 11740 if the ED physician performs subungual hematoma drainage, along with either a nail avulsion or nail bed repair, on the same injury. The codes for these two procedures -- 11730 (Avulsion of nail plate, partial or complete, simple; single) and 11760 (Repair of nail bed) -- include hematoma evacuation, when performed.