Help! I'm having a case of Wednesday-itis!! Ortho surgeon was consulted in the ER for a crushing/degloving injury. Other than finding out the size of the repair, where do I start looking for a code?? Something other than complex repair?? Patient brought the tissue to the ER with her.
PROCEDURE: I repeated a digital block with 50/50 mixture with 0.25% Marcaine and 1% lidocaine, cleaned the skin with Betadine and thoroughly irrigated the wound. Soaked the piece of tissue just briefly for two or three minutes in saline with some minimal tinting with Betadine. I then reprepped the finger and draped it with a circular drape. I closed the laceration over the volar aspect of the middle phalanx with nylon. At that point I opted to graft the free tissue back into place very nicely, not contaminated. I did warn her that there is a chance that, that tissue would not survive. I think her only alternative would be significant shortening, it would be difficult to get soft tissue covered over the volar aspect of that finger and maintain a functional cosmetically appealing finger and nail.
PROCEDURE: I repeated a digital block with 50/50 mixture with 0.25% Marcaine and 1% lidocaine, cleaned the skin with Betadine and thoroughly irrigated the wound. Soaked the piece of tissue just briefly for two or three minutes in saline with some minimal tinting with Betadine. I then reprepped the finger and draped it with a circular drape. I closed the laceration over the volar aspect of the middle phalanx with nylon. At that point I opted to graft the free tissue back into place very nicely, not contaminated. I did warn her that there is a chance that, that tissue would not survive. I think her only alternative would be significant shortening, it would be difficult to get soft tissue covered over the volar aspect of that finger and maintain a functional cosmetically appealing finger and nail.