# Removal of broken needle in deep neck tissue??



## ljones88 (Mar 14, 2018)

Hi all, 

I'm leaning towards 20100 but wanted other's input. A patient was attempting to inject a drug in their neck and the needle broke off. The doctor states the needle tip was found in the deeper tissues of the right supraclavicular fossa deep to the superficial muscle layers above the right clavicle. 

Op report reads:

The patient was placed on the OR table in the supine position. The patient was anesthetized and intubated. A  roll was placed beneath the shoulders. The right neck and chest was prepped and draped in a sterile fashion. A surgical time-out was called. A transverse incision was made directed over the wound in the neck above the right clavicle. The deeper layers were opened with a Bovie. A Weitlaner retractor was inserted and the deeper tissues were dissected with a Metzenbaum scissors beneath the right cephalic vein. The needle tip was identified and extracted easily. The wound was irrigated with saline solution. The needle was sent to pathology and soft tissue was send for culture. The wound edges were debrided and was closed in layers with running Vicryl sutures. The skin was closed with a running Monocryl suture. A sterile dressing was placed over the incision and he patient was extubated and sent to the recovery room in stable condition.

Thanks!


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## Cynthia Hughes (Mar 14, 2018)

*removal of broken needle*

Hi,

I would lean toward 20525 as this appears to better describe the service provided. Code 20520 (simple) could be reported but given the location and that the procedure required anesthesia, I would think this qualifies as complex. You might query the physician for their assessment of simple vs. complicated or deep.

The exploration code is a more intensive service usually reported for open wounds with internal damage that requires repair in addition to removal of any foreign bodies.

I hope that is helpful.
Cindy


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## daedolos (Mar 14, 2018)

What's your Dx?

Peace
?_?
I wonder why there is a 20525 code and the disparity in RVUs. I'm curious if the wound would be considered trauma or complication.


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## hblakeman (Mar 14, 2018)

*20100 vs 20525*

It's my understanding that 20100 does not require the surgeon to incise the skin/tissues to get to the foreign body, but can explore through the penetrating wound.   "He looks for and removes any foreign material, such as fragments of glass, metal, or cloth."  In 20525, "the provider incises the skin over the targeted area and separates the tissues. When she reaches the muscle or tendon sheath, the depth of the foreign body or presence of infection may require more difficult dissection or removal of necrotic, or dead, tissue. She removes the foreign body and closes the surgical opening with sutures after thoroughly cleaning the site."

So, based on your physicians documentation, I would code 20525.


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## daedolos (Mar 14, 2018)

hblakeman said:


> It's my understanding that 20100 does not require the surgeon to incise the skin/tissues to get to the foreign body, but can explore through the penetrating wound.   "He looks for and removes any foreign material, such as fragments of glass, metal, or cloth."  In 20525, "the provider incises the skin over the targeted area and separates the tissues. When she reaches the muscle or tendon sheath, the depth of the foreign body or presence of infection may require more difficult dissection or removal of necrotic, or dead, tissue. She removes the foreign body and closes the surgical opening with sutures after thoroughly cleaning the site."
> 
> So, based on your physicians documentation, I would code 20525.



By your description, 20100 is for a much worse wound than an injection and that's why the RVU is higher.  Makes sense.

Peace
@_*


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## ljones88 (Mar 15, 2018)

Cynthia Hughes said:


> Hi,
> 
> I would lean toward 20525 as this appears to better describe the service provided. Code 20520 (simple) could be reported but given the location and that the procedure required anesthesia, I would think this qualifies as complex. You might query the physician for their assessment of simple vs. complicated or deep.
> 
> ...



Thank you! I didnt even consider that one and the physician is in agreement with that


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