# I & D of Hand



## jdibble (Mar 10, 2011)

Is there a code for an I&D of the metacarpals or would I have to use 10140?  Can someone review the following surgical note from Ortho and let me know if there is a better CPT code to use?

PREOP DIAGNOSIS:  Infected right hand. 

POSTOP DIAGNOSIS:  Infected hematoma of the right hand. 

PROCEDURE:  Incision and drainage with irrigation of the right hand. 

Procedure was as follows:  After the patient was anesthetized, the right upper extremity was prepped and draped in the usual sterile fashion.  Tourniquet was applied but was not used throughout the procedure.  At this time, after a time out to verify the patient, the laterality, antibiotics, etc., a longitudinal incision was made in the area of the 4th metacarpal and subsequently in the area of the second metacarpal.  This was taken down subcutaneously.  It was very edematous.  On putting in a clamp to spread it a little bit, it became evident there was some pus.  It was just a small amount but cultures and sensitivities were done.  There was a small amount of pus also along the other one but it was minimal.  Again, there was a lot of edema.  The wounds were inspected.  I did not see any more pus, even though I palpated the hand and actually pushed on it palmarly, as well as dorsally.  It was therefore irrigated with gentamicin solution.  The thenar eminence was then evaluated and it was still quite swollen.  I was concerned that there might be a pocket of pus there, therefore, a small incision was made right over the muscle itself and the probe was just inserted without any evidence of any either hematoma or pus. This being the situation, all the wounds were copiously irrigated and closed using 4-0 Vicryl subcutaneously and 5-0 nylon for the skin.  A Hemovac drain was inserted so as not to allow any more accumulation of a hematoma.  At this time, the wounds were cleaned and dressed using bacitracin and Adaptic.  A bulky dressing was applied.  Anesthesia was reversed.  The patient tolerated the procedure well and left the OR in good condition. 

Thanks,


----------



## susanp (Mar 10, 2011)

I think 10140 is the best code for the procedure performed.  Depending on the carrier, it might warrant appending modifier 22 since it seems to have been more extensive than just an I&D.  

If this was a postoperative wound then 10180 might be the code to use in this case.


----------



## jdibble (Mar 10, 2011)

Thanks Susan for your help.

I thought that was what I had to use but I was hoping I was missing something and there was another code.  This was not post op either.

Thanks again!


----------

