Procedure: with irrigation debridement of the penetrating left thenar wound. The wound measured approximately 4 cm. Enlargement of the wound, exploration of the wound. Irrigation of the skin and subcutaneous tissue and muscle. And repair of the a small thenar senory branch of the radial nerve.

Op note: Sutures were removed. The arm was elevated, exsanguinated, tourniquet inflated to 225 mmHG. Once the skin was separated the muscle was inspected and found to have a few muscle fibers that were lacerated of the abductor pollicis brevis. In order to expore the wound the wound needed to be lengthened in a Z fashion proximally and distally. Patient was found to have an intact radial and ulnar digital nerves to the thumb. There is only a few fibers lacerated of the abductor pollicis brevis muscle. And there was one small thenar sensory branch fo the radial nerve that was lacerated. After the wound was thoroughly irrigated with antibiotic solution clean gloves, instruments and drapes were applied. The small thenar sensory branch of the radial nerve was repaired with a few interruped suties of 8-0 nylon. The wound was again irrigated with some antibiotic solution. Skin edges were infiltrated with half percent plain Marcaine. Skin was reapproximated with some interrupted sutures of 4-0 nylon. Xeroform dry sterile dressings were applied and patient was placed in a radial gutter splint.

The doc wants to bill 64831 for the repair and 20103 for the enlargement. 20103 is listed as a separate procedure. Does anyone know if these can be billed together and if not, how can I explain this to the insistent doctor?