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Revision of open amputation

  1. #1
    Exclamation Revision of open amputation
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    I need some help folks. I have an op report for a revision of an open amputation with nail removal and full thickness flap. The op report is listed below. I don't see a revision code that fits with the full thickness flap. Any advise would be appreciated.

    DATE OF BIRTH: 12/16/1970

    DATE OF PROCEDURE: 03/16/10

    PREOPERATIVE DIAGNOSIS: Open amputation, right middle finger.

    POSTOPERATIVE DIAGNOSIS: Open amputation, right middle finger.

    PROCEDURES: 1. Revision amputation, right middle finger.
    2. Wound preparation for full thickness skin grafting.
    3. Full thickness skin grafting, right middle finger.
    4. Removal of nail plate.

    ANESTHESIA: General.


    INDICATIONS The patient is a 39-year-old male who at his job sustained an injury to his right middle finger. He had an open amputation. This was last week. I saw him in the office. This was a fairly large area measures almost 2 cm x 1.8 cm. I told him we could try and do some dressing changes but it might take a while since the bone was almost covered, I told him we can then do a full thickness skin graft to get this closed faster if he would like to. The other option is do dressing changes.

    I told him we could also just do dressing change for a while and then go for a skin graft. He states he would like to get this closed as quickly as possible. Therefore we would do a skin graft. The cut was in an oblique fashion so we could not do any type of local flap to get this closed and I told him I had to trim some of the edges. I told him I will take the nail off and it would grow back. He may have a nail deformity and the finger would probably look different than his other fingers.

    DESCRIPTION OF PROCEDURE: The patient was brought to the operating room in stable condition. He was placed on the OR table in the supine position. At this point, an upper arm tourniquet was placed and his right arm was prepped and draped in the usual sterile fashion. At this point, I went ahead and the first thing I did is free up the nail plate and then I removed the nail plate. At this point, it was a little oblique on the ulnar part. I went ahead and trimmed the edges of that. The bone came right up, it was almost covered, but I wanted to cover with subcutaneous tissue therefore I trimmed the bone back with the rongeur just trimming it back probably about 2 mm. Once I did that, I was able to close the subcutaneous tissue by nail with some interrupted 5-0 plain gut making sure the bone was completely covered. At this point, then I went to the antecubital fossa, took the full thickness skin graft and I closed that with some interrupted 4-0 Monocryl and a running 4-0 Monocryl. At this point then I pinned the full thickness skin graft, prepared the wound bed using a curette and elevator and then inset the full thickness skin graft with interrupted 5-0 plain gut. I then put some holes in it. Once that was done, then I put a Xeroform and bacitracin and did a bolster dressing with 4-0 silk tie over. At this point, I put a splint on the finger and wrapped the finger.

    I did perform the digital block prior to doing that with 0.5% Marcaine. The patient then was awakened, extubated and transported to the recovery area in stable condition tolerating the procedure well.

  2. #2
    Greater Pittsburgh
    Check out 26951 (primary or SECONDARY) : 15004: 15240: 11730
    Last edited by jdemar; 03-17-2010 at 12:10 PM.
    jdemar, CPC, CMA

  3. #3
    Thanks, the one that had me confused was the 26951 since it was a full thickness closure.

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