Wiki Splinter under the fingernail

PennyG

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Hoping I can get some responses to this coding question, because I am coming up with a blank as far as the CPT code. Here is the procedure note:

PROCEDURE: Procedure performed is removal of foreign body from underneath the fingernail. Procedure time is 4:10 p.m.. Foreign body location is finger nail of right ring finger. Prior to the procedure, time-out was done, verifying patient's name, date of birth, and procedure to be performed. Patient was placed in a semi-supine position, skin was prepped with alcohol prep pads, and digit was anesthetized using 2-puncture digital block with infiltration of proximally 5 cc of 2% lidocaine without epinephrine, negative aspiration for blood, landmarks visualized and palpated, excellent anesthesia was achieved. Area was then prepped and draped in the usual sterile fashion, and the foreign body was found to be very deep, necessitating removal of the entire fingernail. A large wooden splinter was then removed, and the area was cleansed with copious amounts of tap water and inspected to make sure there were no remaining foreign bodies. The nail bed not require repair. After cleansing, the fingernail was then reinserted under the proximal nail fold and anchored in place using 3 simple interrupted sutures of 4-0 Vicryl material. Patient had a brief episode of near-syncope, likely vasovagal in origin, but did not fall or injure herself, and she quickly recovered. She was given 4 mg Zofran ODT for nausea, and her wound was dressed with bacitracin and bulky dressing. Other than near-syncope, there were no complications, blood loss was minimal, and otherwise patient tolerated the procedure very well. Her tetanus was up-to-date.

Any help will be appreciated. And Thank You, in advance.
 
Still hoping to get some help with this procedure note. As I am reviewing the note, I will need for the provider to clarify how the foreign body was removed. I am trying to decide if I should code a nail avulsion or a foreign body removal. Any assistance will be greatly appreciated.
 
I think you would need the provider to clarify this: "the foreign body was found to be very deep". How deep? You need to know how deep the FB went before you can decide. Was it under the nail? Was it through the nail? How deep was it? You have too many choices without knowing (the 1012_ area, the 2520_ area, etc.) Once you know that, you can decide between those and/or the 1173_ area.
 
Hoping I can get some responses to this coding question, because I am coming up with a blank as far as the CPT code. Here is the procedure note:

PROCEDURE: Procedure performed is removal of foreign body from underneath the fingernail. Procedure time is 4:10 p.m.. Foreign body location is finger nail of right ring finger. Prior to the procedure, time-out was done, verifying patient's name, date of birth, and procedure to be performed. Patient was placed in a semi-supine position, skin was prepped with alcohol prep pads, and digit was anesthetized using 2-puncture digital block with infiltration of proximally 5 cc of 2% lidocaine without epinephrine, negative aspiration for blood, landmarks visualized and palpated, excellent anesthesia was achieved. Area was then prepped and draped in the usual sterile fashion, and the foreign body was found to be very deep, necessitating removal of the entire fingernail. A large wooden splinter was then removed, and the area was cleansed with copious amounts of tap water and inspected to make sure there were no remaining foreign bodies. The nail bed not require repair. After cleansing, the fingernail was then reinserted under the proximal nail fold and anchored in place using 3 simple interrupted sutures of 4-0 Vicryl material. Patient had a brief episode of near-syncope, likely vasovagal in origin, but did not fall or injure herself, and she quickly recovered. She was given 4 mg Zofran ODT for nausea, and her wound was dressed with bacitracin and bulky dressing. Other than near-syncope, there were no complications, blood loss was minimal, and otherwise patient tolerated the procedure very well. Her tetanus was up-to-date.

Any help will be appreciated. And Thank You, in advance.
he foreign body was found to be very deep, necessitating removal of the entire fingernail
- I may consider 11730 - partial or complete removal of a nail. However, the intent was to remove the splinter. Since there is no incision in the note nor documentation that a forcep was used to remove the 'large wooden splinter" the splinter removal is part of the E/M. I may consider querying the the provider if a scapel was used - to add to the note. It is a lot of effort to render it as void of a cpt.
 
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