any suggestions on what you would bill for this?

Irrigation and debridement of the right second, third, and fourth toes.
Intra-articular debridement, left third toe, and pinning of the left third toe using a 0.5 K-wire.
Removal of previous cast, exam under anesthesia, C-arm x-ray, and application of a cast boot.

INDICATIONS: This is a 21-year-old white male who had an ORIF of his left ankle for a syndesmotic injury approximately 10 days ago. Following that, he suffered a gunshot wound to his third toe, which also involved the second and the fourth toes. Examination confirmed an intra-articular fracture, comminuted, of the middle phalanx. Prior to surgery, the risks and benefits of the surgery, including possible need for further amputation, were all clearly explained. The patient understood and wished to proceed.

DESCRIPTION OF PROCEDURE: The patient was brought to the operating room in supine position and general anesthetic was administered and 1 gram of Ancef was given preoperatively. The right foot was prepped and draped in sterile fashion. We then inspected the third toe and noted an intra-articular fracture, comminuted, with entrance wound dorsally on the middle phalanx and exit wound on the volar surface. There was good circulation at the tip. The wound was about 0.5 x 0.5. The examination of the fourth and second toes also showed the skin loss, deep in both areas, with underlying soft tissue present. At this point, we copiously irrigated all three areas. Intra-articular irrigation was undertaken of the third toe. We went ahead and pinned it in the anatomic position. We then went ahead and applied antibiotic cream, then a soft dressing to all three, and a postoperative shoe.

On the left side, we went ahead and removed the cast, examined it under anesthesia and noted it to be stable with two syndesmotic 4.5-mm malleolar screws. We changed the dressing and applied a cast boot. The patient was then awakened and taken to the recovery room in satisfactory condition.