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CPT for distal phalanx fx w/nailbed laceration

R

Rufus186

Networker
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46
Location
Sanford, ME
I'm looking for insight on what cpt to use for a finger distal phalanx fx w/nailbed laceration. The provider removed the remainder of nail which exposed the fx, the phalanx as well as the fx was cleaned with a currette. At that point the phalanx was reduced, the nail bed realigned and closed with simple sutures. Is this enough to justify cpt 26765? Thank you in advance.
 
I would look at 11760 (this includes removal of the residual nail) in addition to 26765 (they do not bundle) - and without looking at the entire note it sounds like you would be good to code these two. You should look at 11011 to see if documentation supports this also (these 3 codes do not bundle). Hope this helps!
 
Thank you for your insight. I was thinking 26765 and 11760 (no debridement of foreign material) but my concern is the surgeon debrided the bone for the reduction of the fracture would that be considered open treatment it is an open fracture? Does this warrant 26765?
 
"Open Treatment is used when the fracture is surgically opened (exposed to the external environment). In this instance, the fracture (bone) is open to view, and internal fixation (pins, screws, etc.) MAY be used. Open treatment can also mean that a remote site (not directly over the fracture) is opened to place a nail (intramedullary) across the fracture site."
Buck, Carol J., and Jackie L. Grass. "Chapter 8 Musculoskeletal System." Next Step - Advanced Medical Coding and Auditing, 2016 Edition. St. Louis: Elsevier Saunders, 2016

CPT Lay Description for 26765 is "The physician performs open reduction of a distal phalangeal fracture of the finger or thumb. The physician uses an x-ray to determine the position and severity of the defect. An incision is made on the overlying skin to expose the fracture and the bones are reapproximated. A wire or plate MAY be placed for internal fixation. The incision is sutured in layers and the hand is splinted."

Hope this helps!!
 
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