ahodge90
Networker
I have a case where my provider says he did a revision of an amputation of the DIP that was traumatically removed before they came to my provider. Per the op note, all he removed was:
Initial copious debridement of the site was noted. There was still a large plantar skin flap that appeared viable. The large bony fragment from the distal phalanx that was still remaining within the flap was debrided out as it was not viable and was no longer functional unit. There was noted to be almost no remaining nail bed. The nail bed that was remaining was removed and then the germinal matrix was also removed to prevent nail growth as without a nail plate to guide growth of the nail and would likely grow back and formed and chronic pain generator for the patient. Once we felt we had an adequate debridement using 3 liters of sterile saline. We re-evaluated to skin edges. Several of the skin edges appeared dusky, nonviable and were debrided back sharply with a knife. At this point, we felt we had good adequate debridement of our nonviable tissue. We had a large plantar flap and was able to be flap over-the-top to allow for closure. Closure performed using a 3-0 nylon suture.
My question is, since he really did not remove much bone, I don't feel like this would qualify as an amputation code-28825. Would this be better with 28124 or 11044?
Any advice is appreciated!
Thanks!
Initial copious debridement of the site was noted. There was still a large plantar skin flap that appeared viable. The large bony fragment from the distal phalanx that was still remaining within the flap was debrided out as it was not viable and was no longer functional unit. There was noted to be almost no remaining nail bed. The nail bed that was remaining was removed and then the germinal matrix was also removed to prevent nail growth as without a nail plate to guide growth of the nail and would likely grow back and formed and chronic pain generator for the patient. Once we felt we had an adequate debridement using 3 liters of sterile saline. We re-evaluated to skin edges. Several of the skin edges appeared dusky, nonviable and were debrided back sharply with a knife. At this point, we felt we had good adequate debridement of our nonviable tissue. We had a large plantar flap and was able to be flap over-the-top to allow for closure. Closure performed using a 3-0 nylon suture.
My question is, since he really did not remove much bone, I don't feel like this would qualify as an amputation code-28825. Would this be better with 28124 or 11044?
Any advice is appreciated!
Thanks!