mjfrog1
Contributor
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
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
I have a couple of suggestions, but it's kind of hit-and-miss depending on who you ask.