Painful "exostosis"??

martnel

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I am sitting here with a very confusion report to code! Any advice would be appreciated!

I saw the pre-surgery pictures, and to me it looked like a little "bubble" sitting on the tip of her toe. The Pathology report says the specimen is unoriented, firm skin segment, but they code Dx 726.91 (Histopathologic changes consistent w/exostosis), which indicates bone.
The Physician coded 733.29 (bone cyst) and 28108, with a note to check this for correct coding. The physician's coder wants to go with 726.91, which then would lead to 28124.
I am wondering since it seems to be skin, should I not use 11421 and 216.7? Then of course, if you read the report, he had to take off the nail and repaired the nailbed. 11760, which include 11752 or was that incidental?

PREOPERATIVE DIAGNOSIS: Painful exostosis, left third toe.

POSTOPERATIVE DIAGNOSIS: Painful exostosis, left third toe.

ANESTHESIA: General.

NAME OF OPERATION: Excision of painful exostosis, left third toe.

.........
Her exostosis was identified. Her nail was removed using a hemostat. This came out of the lateral border of the toe. There was some violation of the nail bed medially and dorsally. The nail bed was elevated using a #15 blade. The exostosis was then trimmed back to the level of the native tip of the distal phalanx. This was confirmed fluoroscopically in the AP and lateral planes. This incision was irrigated with large amounts of normal saline. The nail bed repair was performed with #5-0 chromic suture. The nail was then replaced. The nail was then sewn on using #2-0 Vicryl sutures. A digital block was then performed........
 
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