Desperate Denise
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Hi fellow podiatry coders.
I am actually not a podiatry coder, I just work for a podiatrist. We had a billing service coding for him but they stopped using them. He is supposed to code for himself but he does not.
I am wondering if you could help me with this opnote. He did three of these in one day. He uses 14040 but the billing supervisor says he cannot use this by itself.
I really appreciate your help!!!
Denise
POSTOPERATIVE DIAGNOSES:
1. Ingrown toenail, left hallux.
2. Exostosis, left hallux.
OPERATION PERFORMED:
1. Partial nail avulsion, left hallux.
2. Exostectomy with skin flap, left hallux.
INDICATIONS FOR PROCEDURE: A 61-year-old male presents to Operating Room
with a painful hallux nail of the left foot, which cannot be resolved with
conservative modalities.
DESCRIPTION OF PROCEDURE: The patient was brought in the Operating Room
and placed on the operating table in the supine position. The patient's
left foot was marked in the preoperative area. A timeout was performed at
this time. Following IV sedation 13 mL of 1:1 mixture of 0.5% Marcaine
plain and 1% lidocaine plain was injected into the patient's left foot in
digital nerve block fashion. The patient's left foot was prepped, scrubbed
and draped in the typical aseptic technique. A Penrose drain was used a
noninvasive tourniquet to aid in visualization of the working area.
PARTIAL NAIL AVULSION, LEFT HALLUX:
Attention was then directed to the left lateral hallux border where a Freer
instrument was used to penetrate the eponychium. The lateral nail border
was clipped with an English anvil nail splitter. Then a hemostat was
placed on the border of the nail, rotated towards the center of the nail,
which allowed the lateral nail border to be exposed and removed.
EXOSTOSECTOMY, LEFT HALLUX:
Attention was then directed to the dorsal lateral aspect of left hallux
nail bed proximal to where the nail was just was removed. A 2-cm hockey
stick shape incision was proximal to the lateral nail border with the
transverse extension going laterally at the proximal edge. Using sharp
dissection, the skin was resected. A prominent exostosis of the underlying
bone was noted, so a rongeur was used to resect and smooth up the
prominence. Then, the nail matrix was resected and removed. The bone was
sent off as specimen.
Skin edges were approximated with 4-0 nylon suture in a simple interrupted
suture technique.
A dressing was applied consisting of Betadine-soaked Adaptic, 4 x 4 gauze,
Kling, Kerlix and Ace wrap. Postoperative care was started in the
Operating Room. The patient tolerated the procedure well. No
complications and was discharged home with vital signs stable and vascular
status intact to the left foot. The patient was given postoperative
I am actually not a podiatry coder, I just work for a podiatrist. We had a billing service coding for him but they stopped using them. He is supposed to code for himself but he does not.
I am wondering if you could help me with this opnote. He did three of these in one day. He uses 14040 but the billing supervisor says he cannot use this by itself.
I really appreciate your help!!!
Denise
POSTOPERATIVE DIAGNOSES:
1. Ingrown toenail, left hallux.
2. Exostosis, left hallux.
OPERATION PERFORMED:
1. Partial nail avulsion, left hallux.
2. Exostectomy with skin flap, left hallux.
INDICATIONS FOR PROCEDURE: A 61-year-old male presents to Operating Room
with a painful hallux nail of the left foot, which cannot be resolved with
conservative modalities.
DESCRIPTION OF PROCEDURE: The patient was brought in the Operating Room
and placed on the operating table in the supine position. The patient's
left foot was marked in the preoperative area. A timeout was performed at
this time. Following IV sedation 13 mL of 1:1 mixture of 0.5% Marcaine
plain and 1% lidocaine plain was injected into the patient's left foot in
digital nerve block fashion. The patient's left foot was prepped, scrubbed
and draped in the typical aseptic technique. A Penrose drain was used a
noninvasive tourniquet to aid in visualization of the working area.
PARTIAL NAIL AVULSION, LEFT HALLUX:
Attention was then directed to the left lateral hallux border where a Freer
instrument was used to penetrate the eponychium. The lateral nail border
was clipped with an English anvil nail splitter. Then a hemostat was
placed on the border of the nail, rotated towards the center of the nail,
which allowed the lateral nail border to be exposed and removed.
EXOSTOSECTOMY, LEFT HALLUX:
Attention was then directed to the dorsal lateral aspect of left hallux
nail bed proximal to where the nail was just was removed. A 2-cm hockey
stick shape incision was proximal to the lateral nail border with the
transverse extension going laterally at the proximal edge. Using sharp
dissection, the skin was resected. A prominent exostosis of the underlying
bone was noted, so a rongeur was used to resect and smooth up the
prominence. Then, the nail matrix was resected and removed. The bone was
sent off as specimen.
Skin edges were approximated with 4-0 nylon suture in a simple interrupted
suture technique.
A dressing was applied consisting of Betadine-soaked Adaptic, 4 x 4 gauze,
Kling, Kerlix and Ace wrap. Postoperative care was started in the
Operating Room. The patient tolerated the procedure well. No
complications and was discharged home with vital signs stable and vascular
status intact to the left foot. The patient was given postoperative
