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Finger amputation CPT code

  1. #1
    Location
    Anchorage,Alaska
    Posts
    13
    Question Finger amputation CPT code
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    Can someone please confirm that CPT 26951 is the correct code for the following procedure?
    Preop DX: Traumatic amputation, right index finger with fracture through the distal phalangeal physis.
    Procedure: Patient was taken to the op room and placed on the table.The right upper extremity was sterilely prepped and draped after the administration of the general anesthetic. The finger tip was then examined. Upon initial presentation in the ER dept. The finger tip was rotated by 180 degrees with a nail on the volar surface. This was reduced in the ER and upon exam under anesthesia, it is apparent that the only remaining attachmentis the flexor tendon. There was no soft tissue attachment whatsoever and no perfusion obviously of the tip of the finger. The decision was therefore made to complete the amputation by transecting the flexor tendon and then using the skin from the tip as graft in order to cover exposed bone and preserve as much length as possible. The nail was removed with an tiris scissors and then the nail bed and remainder of the distal phalanx was then dissected free. The subcutaneous tissues were dissected off of the skin and dermis. This was then placed over the tip of the finder. There was no contamination whatsoever. The nail had been avulsed from the tip and there was a small amount of germinal matrix appearing tissue on the ulnar side of the finger tip. This was removed with a scalpel. The graft was then sutured with 4-0 chromic suture. An initial dorsal stay suture was placed and then further stitches were placed around the circumference with the skin being trimmed as necessary to provide good coverage without any tension and without creating a pocket for hematoma formation. There was capillary bleeding from the distal tip of the finger, but this was minimal. The coverage was quite good. The fingers and hand was then cleaned with saline. A metacarpal block was done with .25% marcaine. A sterile dressing of Xeroform and two gauze was then applied which was tied around the wrist and then this was covered with Coban. Pt doing well transferred to postop for recovery.

    Did an amputation of the bone in the finger happen? I do not read where any part of the bone was cut. I see where the bone was covered, but no bone was cut out.
    What do you think, correct CPT code or if not any suggestions? Thank you.

  2. #2
    Location
    Salt Lake North
    Posts
    842
    Default Fracture went through the bone
    There was a fracture of the distal phalanx, and in the note the physician states that he dissected the remaining portion of the bone free. This was not an amputation at the joint, the amputation was through the bone is how I am seeing this.

  3. #3
    Location
    Greensboro, NC
    Posts
    73
    Default
    I would go with 26952:
    Documentation states, "...The decision was therefore made to complete the amputation." and "...distal phalanx was then dissected free."

    CPT lay descriptions:
    26951-26952 (26951, 26952)
    The physician amputates a finger or thumb, primary or secondary to injury. Neurectomies are performed. The overlying skin is incised and the tissues are dissected to the bone. The bone is removed. The vessels and nerves are ligated using microsurgical techniques. Primary amputation is removal of the digit following an acute injury or infection. Secondary amputation occurs when earlier attempts to preserve the digit have failed. In 26951, the wound is approximated, reduced, and sutured in layers. In 26952, local advancement flaps are necessary for closure.

    https://www.orthobullets.com/hand/60...d-finger-flaps

  4. #4
    Location
    Anchorage,Alaska
    Posts
    13
    Default
    Quote Originally Posted by Orthocoderpgu View Post
    There was a fracture of the distal phalanx, and in the note the physician states that he dissected the remaining portion of the bone free. This was not an amputation at the joint, the amputation was through the bone is how I am seeing this.
    Quote Originally Posted by fish4codes View Post
    I would go with 26952:
    Documentation states, "...The decision was therefore made to complete the amputation." and "...distal phalanx was then dissected free."

    CPT lay descriptions:
    26951-26952 (26951, 26952)
    The physician amputates a finger or thumb, primary or secondary to injury. Neurectomies are performed. The overlying skin is incised and the tissues are dissected to the bone. The bone is removed. The vessels and nerves are ligated using microsurgical techniques. Primary amputation is removal of the digit following an acute injury or infection. Secondary amputation occurs when earlier attempts to preserve the digit have failed. In 26951, the wound is approximated, reduced, and sutured in layers. In 26952, local advancement flaps are necessary for closure.

    https://www.orthobullets.com/hand/60...d-finger-flaps
    Thank you.

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