# granuloma mass & nail excision help



## BFAITHFUL (Sep 13, 2009)

I have here an op report for excision of nail plate removal & granulomatous mass removal  Should this be coded as a foreign body removal?  I'm thinking 11730 & 28193 not sure if this considered complicated?

dx:  granulomatous mass 

operation: excision of nail plate
               excision of granulomatous mass with possible inclusion cyst


A freer elevator was used to free the nail plate from the nail bed.  The nail plate was removed in toto from the nail bed.  A granulomatous mass was noted under the nail, which was noted preoperatively, but was significantly larger after the nail plate was removed.  This granulomatous mass was at the tip of the second toe and ran to about the mid part of the distal phalanx of the second toe.  Through a series of sharp and blunt dissections, this granulomatous mass was outlined and removed in toto.  As the mass was rmoved, a white mass was noted at the end of the granuloma.  This was attached to the granuloma and surrounding the granuloma.  It is notknown what this white mass was and will be sent for biopsy.  There was a hole left in the toe so one could peer down into the tip of the toe.  There was no pus.  There was no noted necrosis.  The tip of the distal phalanx appeared normal.  The area around the granuloma appeared normal with the exception of some skin that was hypertrophic.  This was all removed.  With this being done, two nylong sutures were criss-crossed across the tip of the toe to allow the hole to close a little bit more properly.  With this done, the area was inspected again for any abnormalities, none were seen.  The area was wrapped using a dry sterile dressing and a fluff bandage.


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