Since orthopedics is not my specialty I'd like to get your opinions on how this is coded. Isn't the debridement included in the amputation procedure??
Preoperative Diagnosis:
Crush injury to the tips of the left thumb, index, long ring and small with open fractures of the index, long and ring and pretty substantial soft tissue loss on the index, ling and ring.
Postoperative Diagnosis:
Crust injury to the tips of the left thumb, index, long, ring and small with open fractures of the index, long and ring and pretty substantial soft tissue loss on the index, long, and ring.
Procedure:
Exploration of wounds using pulse lavage and subsequent simple repair of the thumb and small finger and revision amputations of the index, long, ring to the level of the DIP joint.
Description of the Procedure:
After an informed consent was obtained, the patient was taken to the operating room and was given MAC sedation. Pt was actually presedated coming from the ER. We subsequently gave pt digital blocks using 30cc of 0.25% Marcaine without epinephrine. Pt underwent a 10 minute Betadine prep and was sterilely draped in the usual fashion. The thumb, long, ring and small fingers were exsanguinted with a three-quarter inch Penrose drain and the tourniquet was secured at the base of the fingers.
These were then irrigated with six liters of normal saline using a pulse lavage system. The thumb and small finger were simply debrided and closed primarily. The index, long and ring showed substantial tissue loss with personal nail bed loss on each of these. The distal phalanges were very comminuted especially on the middle finger and our goal was to get immediate coverage with a minimal risk of having to come back and redo this and to need any additional procedures.
The index, long and ring fingers were resected down to the DIP joint. The flexor digitorum profundus each was pulled out, cut and allowed to retract. Neurectomies were performed on each of these when the digital nerve could be located. The volar plate was removed. Bony prominences around the condyles were taken down. The bone was decorticated on the surface so this would have a surface that would adhere to the tissue as it healed so that the tip of the finger would not slide around. These were smoothed off with a rasp. The tissue then was flapped over the tip of the finger. The injury pattern developed the type of the flap. Once the flaps were completed, the tourniquet was released in each of the fingers individually and there was excellent flow through each of the flaps. Each finger was then dressed wit xeroform, bacitracin, conform and coban wrap. The patient was given an additional 30 cc of .25% Marcaine digital blacks in the thumb, index, long, ring and small just prior to the termination of the case.
26952-LT, F1
26952-51-59 LT, F2
26592-51-59 LT, F3
Wouldn't debridement be included in the 26952?
11044???
12001-51,LT, FA,F4 (Thumb and small finger laceration repair)
Needing your opinions please.
Preoperative Diagnosis:
Crush injury to the tips of the left thumb, index, long ring and small with open fractures of the index, long and ring and pretty substantial soft tissue loss on the index, ling and ring.
Postoperative Diagnosis:
Crust injury to the tips of the left thumb, index, long, ring and small with open fractures of the index, long and ring and pretty substantial soft tissue loss on the index, long, and ring.
Procedure:
Exploration of wounds using pulse lavage and subsequent simple repair of the thumb and small finger and revision amputations of the index, long, ring to the level of the DIP joint.
Description of the Procedure:
After an informed consent was obtained, the patient was taken to the operating room and was given MAC sedation. Pt was actually presedated coming from the ER. We subsequently gave pt digital blocks using 30cc of 0.25% Marcaine without epinephrine. Pt underwent a 10 minute Betadine prep and was sterilely draped in the usual fashion. The thumb, long, ring and small fingers were exsanguinted with a three-quarter inch Penrose drain and the tourniquet was secured at the base of the fingers.
These were then irrigated with six liters of normal saline using a pulse lavage system. The thumb and small finger were simply debrided and closed primarily. The index, long and ring showed substantial tissue loss with personal nail bed loss on each of these. The distal phalanges were very comminuted especially on the middle finger and our goal was to get immediate coverage with a minimal risk of having to come back and redo this and to need any additional procedures.
The index, long and ring fingers were resected down to the DIP joint. The flexor digitorum profundus each was pulled out, cut and allowed to retract. Neurectomies were performed on each of these when the digital nerve could be located. The volar plate was removed. Bony prominences around the condyles were taken down. The bone was decorticated on the surface so this would have a surface that would adhere to the tissue as it healed so that the tip of the finger would not slide around. These were smoothed off with a rasp. The tissue then was flapped over the tip of the finger. The injury pattern developed the type of the flap. Once the flaps were completed, the tourniquet was released in each of the fingers individually and there was excellent flow through each of the flaps. Each finger was then dressed wit xeroform, bacitracin, conform and coban wrap. The patient was given an additional 30 cc of .25% Marcaine digital blacks in the thumb, index, long, ring and small just prior to the termination of the case.
26952-LT, F1
26952-51-59 LT, F2
26592-51-59 LT, F3
Wouldn't debridement be included in the 26952?
11044???
12001-51,LT, FA,F4 (Thumb and small finger laceration repair)
Needing your opinions please.