HELP WITH PROPER 7TH DIGIT ON ICD 10 ON THIS OPERATIVE NOTE

[cherylbr]

Postoperative diagnosis:
1. Left middle finger proximal phalanx fracture.
2. Left ring finger proximal phalanx fracture.
3. Left small finger proximal phalanx fracture.

Procedure performed:
1. Left middle finger proximal phalanx intra-articular fracture, closed treatment.
2. Left ring finger proximal phalanx osteotomy with fixation of intra-articular fracture.
3. Left small finger proximal phalanx head fracture, closed treatment.

This is a 56-year-old female who suffered one obvious fracture of the ring finger
proximal phalanx. On exam and x-rays in the office, it appeared she had other fractures. I sent
her for a CT scan, which confirmed she had 3 fractures total.
All three fractures showed healed and the ring finger healed with malunion.
per office records:
pt doi 5-9
pt office visits 5-15 & 5-18
surgery postponed due to elevated blood pressure
surgery performed 6-04.

I am in question on the 7th digits for all three fractures. A,D, P?

TIA!
Cheryl

 

[amyjph]

What is the encounter date and type you are trying to code? What is the sequence of events here?
The info is conflicting/confusing the way it is. The first part looks like a copy/paste from the op note, but is the rest a post op follow up office visit? Are you coding for the post op? Because this: "All three fractures showed healed and the ring finger healed with malunion." would dictate the dx codes but that does not match what the postop dx says.
This documentation is confusing. You can't bill for closed treatment on a healed fracture...