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pamasbury
09-03-2008, 02:47 PM
Since orthopedics is not my specialty I'd like to get your opinions on how this is coded. Isn't the debridement included in the amputation procedure??

Preoperative Diagnosis:

Crush injury to the tips of the left thumb, index, long ring and small with open fractures of the index, long and ring and pretty substantial soft tissue loss on the index, ling and ring.



Postoperative Diagnosis:

Crust injury to the tips of the left thumb, index, long, ring and small with open fractures of the index, long and ring and pretty substantial soft tissue loss on the index, long, and ring.



Procedure:

Exploration of wounds using pulse lavage and subsequent simple repair of the thumb and small finger and revision amputations of the index, long, ring to the level of the DIP joint.



Description of the Procedure:

After an informed consent was obtained, the patient was taken to the operating room and was given MAC sedation. Pt was actually presedated coming from the ER. We subsequently gave pt digital blocks using 30cc of 0.25% Marcaine without epinephrine. Pt underwent a 10 minute Betadine prep and was sterilely draped in the usual fashion. The thumb, long, ring and small fingers were exsanguinted with a three-quarter inch Penrose drain and the tourniquet was secured at the base of the fingers.

These were then irrigated with six liters of normal saline using a pulse lavage system. The thumb and small finger were simply debrided and closed primarily. The index, long and ring showed substantial tissue loss with personal nail bed loss on each of these. The distal phalanges were very comminuted especially on the middle finger and our goal was to get immediate coverage with a minimal risk of having to come back and redo this and to need any additional procedures.



The index, long and ring fingers were resected down to the DIP joint. The flexor digitorum profundus each was pulled out, cut and allowed to retract. Neurectomies were performed on each of these when the digital nerve could be located. The volar plate was removed. Bony prominences around the condyles were taken down. The bone was decorticated on the surface so this would have a surface that would adhere to the tissue as it healed so that the tip of the finger would not slide around. These were smoothed off with a rasp. The tissue then was flapped over the tip of the finger. The injury pattern developed the type of the flap. Once the flaps were completed, the tourniquet was released in each of the fingers individually and there was excellent flow through each of the flaps. Each finger was then dressed wit xeroform, bacitracin, conform and coban wrap. The patient was given an additional 30 cc of .25% Marcaine digital blacks in the thumb, index, long, ring and small just prior to the termination of the case.


26952-LT, F1
26952-51-59 LT, F2
26592-51-59 LT, F3

Wouldn't debridement be included in the 26952?
11044???

12001-51,LT, FA,F4 (Thumb and small finger laceration repair)

Needing your opinions please.

pwilson
09-03-2008, 03:33 PM
It is my understanding that the debridement code 11044 would be included in the amputation code 26592. 11044 would apply to debridement during open fracture or open treatment of a dislocation, when amputation is not done.

pamasbury
09-03-2008, 05:17 PM
Any idea where I could find that in writing?

FTessaBartels
09-03-2008, 05:37 PM
I'm not an expert on ortho, either, but ...

I was taught that any time it's a "new incision" you would want to use modifier 59 NOT 51.

So, I'd use only modifier -59 (plus the appropriate digit modifiers) on your codes, including the lac repairs.

F Tessa Bartels, CPC, CPC-E/M

pamasbury
09-03-2008, 09:25 PM
Thank you. I appreciate your response!

ceverlith
09-08-2008, 11:25 PM
Pamasbury:

The debridement that you should be using is code 11012, this is the debridement of an open fracture and this is to be coded in addition to the procedure performed 26952 and should be coded for the F1, F2 and F3 fingers. Your diagnosis supports this as well. 13 years of coding hand comes in handy (no pun intended)

____________
Ceverlith, CPC

mbort
09-09-2008, 09:34 AM
I agree with Ceverlith, the 11011-11012 can and should be used. Of note is that these codes are not specifically for open fractures and can be used for closed fractures that require ORIF with debridement as well. I've copied the CPT assistant regarding this.


Year: 1997

Issue: April

Pages: 10

Title: Integumentary, 11010-11012 (Q&A)

Body: Coding Consultation

Question

Does an open fracture have to be present in order to report the fracture debridement codes, or can they be reported for a closed fracture?

AMA Comment

While the debridement codes are intended to be reported in cases of an open fracture, there may be examples when debridement is necessary to treat a fracture site when no open fracture is present. Per official ICD-9 CM coding guidelines, fractures can be defined as follows.

Closed Fracture: A fracture that does not produce an open wound in the skin.

Open Fracture: A fracture in which a wound, through the adjacent or overlying soft tissues, communicates with the site of the break.

Example: In a traumatic fracture injury, the skin is damaged extensively, causing massive involvement of the surrounding soft tissues and requires significant debridement, however, the wound is not involved down to the fracture.

In this circumstance, the fracture is not classified with the ICD-9 diagnosis code as an open fracture. Nevertheless, it is appropriate to report CPT code 11010-11012 (as appropriate) to describe the debridement performed.


© 2005 American Medical Association




Hope this helps
Mary