Please help, coding operative report--finger amputations

mjfrog1

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Here is the operative report:


PREOPERATIVE DIAGNOSIS: 1. Left 2nd distal phalanx amputation. 2. Left 3rd distal phalanx amputation with nailbed injury.

POSTOPERATIVE DIAGNOSIS: 1. Left 2nd distal phalanx amputation. 2. Left 3rd distal phalanx amputation with nailbed injury.

OPERATION PERFORMED: 1. Left 2nd phalanx amputation revision. 2. Left 3rd amputation and revision. 3. Excision of nailbed and nail matrix left 3rd. 4. Full-thickness skin graft from palm to left index, greater than 3cm.sq.


PROCEDURE: The patient was taken to the operating room and given PO antibiotics preoperatively. The patient was given general anesthesia without difficulty. Tourniquet was placed on the proximal left upper extremity. The left upper extremity was then prepped and draped in usual sterile fashion. The left upper extremity was exsanguinated using Ace bandage and tourniquet was raised to 250mmHg. He was given digital block as well using 2% lidocaine without epinephrine. We then irrigated the wound. The 2nd digit was revised for better contouring. We rongeured back bone as necessary. We also then sharply revised skin and subcutaneous tissue. Neurectomies were performed. A graft was taken greater than 3 x 3cm. This was then defatted and sutured to the end of the 2nd digit in appropriate fashion. This wound was copiously irrigated.

Our attention was then directed at the 3rd digit. This had more extensive damage and the injury more proximal. This was near the proximal nail with remaining nailbed in the matrix. This was removed with potential permanent removal. We then revised the skin and subcutaneous tissue sharply. Neurectomies were performed. We then rongeured back bone to the appropriate level. We were then able to close skin and subcutaneous tissue with appropriate suture technique.

Wounds were cleaned and dried and appropriate dressing was placed. Tourniquet was released with good return of distal capillary refill.

The patient was awakened and taken to the recovery room in stable condition. Blood loss was minimal. No complications.


OF NOTE: My state workers compensation program is stating that "since the patient already had his fingers amputated due to the accident," that it would be inappropriate to report the CPT codes: 26951-F1, 26951-F2 & 15240 (these are the ones I used to submit to workers comp). Workers comp suggested using the following codes: 13132, 15100, 64776-F1, 64776-F2


Thanks for any help!

Sue, CPC, CCS-P
 
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First, I don't think the people at the WC carrier know how to code. 15100 is for trunk arms and legs... :rolleyes: I have a couple of suggestions, but it's kind of hit-and-miss depending on who you ask.

I somewhat agree that these aren't an amputation since most of the amputation already happened. Nonetheless, you might be better off billing differently anyway because it could mean higher reimbursement. I don't know if your state has a fee schedule for WC, but you might want to look there to figure out what to pick.

For the 3rd digit -
13132 for the complex repair -or- 11044 for the debridement and 12002 for the closure (and maybe 11730 for the nail).

For the 2nd digit -
Because the debridement was extensive, you can bill for both the debridement and the graft. There's documentation all over the place to attest to that.
15240 for the graft and 11044 for the debridement (you'll need a modifier for the bundle). I don't know if you could get by with billing the prep 15004.
I don't know why they want you to use a split-thickness, but if push comes to shove, I suppose you could use 15120 for the graft instead.

64776 is just way wrong, IMO.

Thoughts?
 

mjfrog1

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Thanks for your timely post. I apologize for the delay in my reply. I agree, my state workers comp carrier does not know how to code (at least not on this one!)

I have decided to use CPT codes 13132-F2, 11750-F2, 15120, 11044. I also sent this message to them: 64776 is excision of neuroma (which this was not) cannot be used. 15100 is split thickness for arms and legs, this cannot be used as the wound is to the fingers/hand.

Again, thanks for your help!
Sue;)




First, I don't think the people at the WC carrier know how to code. 15100 is for trunk arms and legs... :rolleyes: I have a couple of suggestions, but it's kind of hit-and-miss depending on who you ask.

I somewhat agree that these aren't an amputation since most of the amputation already happened. Nonetheless, you might be better off billing differently anyway because it could mean higher reimbursement. I don't know if your state has a fee schedule for WC, but you might want to look there to figure out what to pick.

For the 3rd digit -
13132 for the complex repair -or- 11044 for the debridement and 12002 for the closure (and maybe 11730 for the nail).

For the 2nd digit -
Because the debridement was extensive, you can bill for both the debridement and the graft. There's documentation all over the place to attest to that.
15240 for the graft and 11044 for the debridement (you'll need a modifier for the bundle). I don't know if you could get by with billing the prep 15004.
I don't know why they want you to use a split-thickness, but if push comes to shove, I suppose you could use 15120 for the graft instead.

64776 is just way wrong, IMO.

Thoughts?
 
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