# subungual tumor excision



## ksobota (Nov 16, 2015)

Need help with a cpt code(s)!  If anyone has some input that would be great.

Preop dx: RT index finger subungual tumor
Postop dx: Granuloma w/ foreign body

Proc: 1.  Excision of RT subungual tumor w/ repair of the nail bed
2. Removal of foreign body, RT subungual space

Op:  After informed decision was obtained, the patient was brought to the operating room and laid in the supine position.  After successful endotracheal anesthesia and appropriate time-out taken she was prepped and draped in the usual sterile fashion.  At this point, an Esmarch was then used on her right hand and arm, exsanguinated the blood, and tourniquet was insufflated to 250 mmHg for a total of approximately 10 minutes.  During that time an iris scissors was then used to separate the nail from the nail bed all the way up to the eponychium and on the proximal end and each lateral side.  Then, the nail was removed and saved on the back table.  During that time, I then inspected the avascular nail bed.  There appeared to be a foreign body block in subnail bed at the hyponichial area.  I removed that and sent it to pathology.  There was also an area o hypergranulation most likely a pyogenic granuloma.  Nevertheless, it was excised with tenotomy scissors down to the level almost to the bone of the distal phalanx.  That specimen was sent to pathology.  Then cautery was used to cauterize the base and the tourniquet was let down and minimal bleeding was encountered from that area.  The nail bed was then repaired by placing the nail back on it and suturing it with a 4-0 prolene as a splint to allow the nail bed to create new nail.  The finger was the anesthetized with 0.25% marcain in a digital block fashion.  A total of about 8 mL were used.  Then, a finger Tubegauz dressing was applied on the top of the finger without much tension to be ischemic.  The patient tolerated the procedure well.  

My co-worker and I have looked at 114xx excision, 11760, 11755 and a few more and we just can't decide on what would best apply.  Any help would be much appreciated!


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## dclark7 (Nov 17, 2015)

Have you looked at 26115 or 26116?  The physician doesn't give you the size, but if you have the path report you can refer back to that.


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## ksobota (Nov 27, 2015)

Thanks so much!  It does look much better.  I don't know how I missed these before.  I really appreciate the help.


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