cclarson
Guru
Pt had their nail plate removed to reach a mass underneath, partial removal of the nailbed was done in the process. Pathology revealed that it was subungual exostosis. How would I code this procedure? Here is the report. Thank you in advance!
POSTOPERATIVE DIAGNOSIS:
Right thumb nailbed mass.
PROCEDURE PERFORMED:
Excision of a mass from the right thumb nailbed.
Indications:
An 8-year-old male presents with a mass that has been enlarging over his right thumb nailbed and he and his parents elect to proceed with excisional biopsy. Risks benefits and alternatives were discussed with the patient and they elect to proceed. Informed consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and placed supine with the right hand on the hand table. Anesthesia was induced. The arm was then prepped and draped in normal sterile fashion. Timeout was performed and preoperative antibiotics were given.
An Esmarch tourniquet was used. We elevated the nail plate off of the nailbed. The mass was over the radial border of the nail in the paronychia. It seemed to be pushing the paronychia away. This was sharply excised full thickness down to the proximal phalanx. There was an area of the nailbed that appeared to be involved as well and this was excised as a small separate fragment. A rongeur was used to smooth off and excise a segment of bone for biopsy.
The wound was then irrigated. Chromic sutures were used to repair the paronychia to the nailbed and then the nail plate was sutured back underneath the nail fold. The tourniquet was removed. The wound was irrigated and then a thumb spica splint was applied. The patient tolerated the procedure well without complication.
POSTOPERATIVE DIAGNOSIS:
Right thumb nailbed mass.
PROCEDURE PERFORMED:
Excision of a mass from the right thumb nailbed.
Indications:
An 8-year-old male presents with a mass that has been enlarging over his right thumb nailbed and he and his parents elect to proceed with excisional biopsy. Risks benefits and alternatives were discussed with the patient and they elect to proceed. Informed consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and placed supine with the right hand on the hand table. Anesthesia was induced. The arm was then prepped and draped in normal sterile fashion. Timeout was performed and preoperative antibiotics were given.
An Esmarch tourniquet was used. We elevated the nail plate off of the nailbed. The mass was over the radial border of the nail in the paronychia. It seemed to be pushing the paronychia away. This was sharply excised full thickness down to the proximal phalanx. There was an area of the nailbed that appeared to be involved as well and this was excised as a small separate fragment. A rongeur was used to smooth off and excise a segment of bone for biopsy.
The wound was then irrigated. Chromic sutures were used to repair the paronychia to the nailbed and then the nail plate was sutured back underneath the nail fold. The tourniquet was removed. The wound was irrigated and then a thumb spica splint was applied. The patient tolerated the procedure well without complication.