Wiki Crush Injury with Tuft Fracture

[LLRodgers]

Hello,

Can anyone help me with some cpt codes.

Patient has crush injury to the right middle finger. Dr. attempted to reduce the nail into the bed, however, it would not stay in this position. Therefore, a digital block was performed with 3 mL of 1% plain lidocaine, then a single 3.0 Prolene suture was placed. at the bas of the nail pulling the nail back into the cuticle.

I came up with 64450 for the digital block and then 11760 for Nail Bed Repair.

Can anyone tell me if these would be correct and if I can use both or just one or would 11760 cover both?

Thank you,

LLR

 

[AlanPechacek]

You are correct with 11760, which is technically for "Nail Bed Repair," which your physician did indirectly by replacing the nail in its anatomic position and suturing it in place since it would not stay there without the suture. In these injuries, the nail is usually avulsed from it roots proximally, and at some point more distally the nail bed is also lacerated/torn at a point under the nail, particularly if there is a tuft fracture (which is pretty much ignored). By saving the nail (rather than removing it completely) and putting it back where it belongs, along with the attached damaged nail bed, he has done a nail bed repair, using the nail as a "Splint" to protective nail bed "repair" under it.

This would reasonably require some form of anesthesia to accomplish, as I doubt there is any patient who could tolerate this procedure without some. If he had done "local anesthesia" by local infiltration at the injury site, I would believe this type of anesthesia would be included in the 11760. But, since he "technically" did a adjunct procedure of "digital block" (64450) in order to perform the surgical procedure, then I would consider it a separate procedure and bill for it as well. Your insurance company may not agree, but it is worth a try.

Hopefully this helps.

Alan Pechacek, M.D.
icd10orthocoder.com