AR2728
Expert
See attached op report. I'm wondering if it would be appropriate to bill this as Phalangectomy for a diabetic patient with malignant melanoma that was larger than anticpated and due to diabetes and concerns with skin graft healing physician opted for amputation and flap closure.
The lesion itself was actually 1.5 cm to 2.0 cm in greatest
diameter initially and as it was larger than anticipated, it became apparent that this was
too large of a defect to close primarily. There was also concern with the patient's age and
diabetes concerning healing of a skin graft. The subsequent defect was approximately
2.5 X 3.5 to 4.0 cm, and therefore it was decided to proceed with a toe amputation for
flap closure. The entire medial aspect of the toe had been opened up and this was carried
down to the underlying bone in the mid proximal phalanx. This was dissected free
circumferentially and divided. The soft tissue was then dissected off of the bone distally
down towards the tip of the toe. Circumferential incision was made and the nail bed was
resected with a sharp circumferential incision extending down to bone. The nail bed and
the underlying bone were then dissected free from the surrounding subcutaneous tissues
and the toe amputation completed with the bone removed along with the tip of the nail
bed and skin. The hemostasis was obtained with fine Vicryl sutures. The proximal bone
stump was then rounded with a rasp and a ronger. Soft tissue was reapproximated over
the bone with #4-0 Vicryl suture. The skin flap on the lateral and plantar surface of the
toe which remained was trimmed and was brought up and rotated over to cover the
subsequent defect
The lesion itself was actually 1.5 cm to 2.0 cm in greatest
diameter initially and as it was larger than anticipated, it became apparent that this was
too large of a defect to close primarily. There was also concern with the patient's age and
diabetes concerning healing of a skin graft. The subsequent defect was approximately
2.5 X 3.5 to 4.0 cm, and therefore it was decided to proceed with a toe amputation for
flap closure. The entire medial aspect of the toe had been opened up and this was carried
down to the underlying bone in the mid proximal phalanx. This was dissected free
circumferentially and divided. The soft tissue was then dissected off of the bone distally
down towards the tip of the toe. Circumferential incision was made and the nail bed was
resected with a sharp circumferential incision extending down to bone. The nail bed and
the underlying bone were then dissected free from the surrounding subcutaneous tissues
and the toe amputation completed with the bone removed along with the tip of the nail
bed and skin. The hemostasis was obtained with fine Vicryl sutures. The proximal bone
stump was then rounded with a rasp and a ronger. Soft tissue was reapproximated over
the bone with #4-0 Vicryl suture. The skin flap on the lateral and plantar surface of the
toe which remained was trimmed and was brought up and rotated over to cover the
subsequent defect