# Fracture Care??



## sla696 (Feb 23, 2010)

Thoughts??  I am leaning toward open fracture care.  Provider billed 11760 & 12001; which I disagree. 

WOUND TREATMENT/REPAIR: 1.5 cm deep laceration of the laceration across the central nail bed that extends across the ulnar nail fold deeply into the pulp of the finger.  Left little finger.  Full thickness wound.  Wound extends to the subcutaneous tissue.  Skin margins jagged.  After skin cleansing, wound was anesthetized with lidocaine 2% as a digital block.  Wound scrubbed with Hibiclens.  Carefully explored.  Nail excised to expose nail bed laceration The area of the laceration in the nail bed was exposed by excising adjacent finger nail.  The laceration extended beneath the base of the nail fold.  In order to expose this portion of the nail bed laceration, longitudinal incisions were made on the radial and ulnar aspect of the nail base of the nail fold in order to elevate the base of the nail bed.  This area was repaired with interupted 6-0 vicryl sutures.  A complex laceration of the central portion and tip of the nail bed was identified and repaired.  Prior to repair of the nail bed, the displaced tuft fracture was reduced.  Post repair, the tuft facture was stable.The nail bed laceration was repaired with interupted 6-0 vicryl sutures.  The laceration of the pulp was repaired with interrupted 6-0 nylon sutures.  The wound was dressed with an occlusive gauze coban dressing.


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## Bella Cullen (Feb 24, 2010)

sla696 said:


> Thoughts??  I am leaning toward open fracture care.  Provider billed 11760 & 12001; which I disagree.
> 
> WOUND TREATMENT/REPAIR: 1.5 cm deep laceration of the laceration across the central nail bed that extends across the ulnar nail fold deeply into the pulp of the finger.  Left little finger.  Full thickness wound.  Wound extends to the subcutaneous tissue.  Skin margins jagged.  After skin cleansing, wound was anesthetized with lidocaine 2% as a digital block.  Wound scrubbed with Hibiclens.  Carefully explored.  Nail excised to expose nail bed laceration The area of the laceration in the nail bed was exposed by excising adjacent finger nail.  The laceration extended beneath the base of the nail fold.  In order to expose this portion of the nail bed laceration, longitudinal incisions were made on the radial and ulnar aspect of the nail base of the nail fold in order to elevate the base of the nail bed.  This area was repaired with interupted 6-0 vicryl sutures.  A complex laceration of the central portion and tip of the nail bed was identified and repaired.  Prior to repair of the nail bed, the displaced tuft fracture was reduced.  Post repair, the tuft facture was stable.The nail bed laceration was repaired with interupted 6-0 vicryl sutures.  The laceration of the pulp was repaired with interrupted 6-0 nylon sutures.  The wound was dressed with an occlusive gauze coban dressing.



Well this is definitely NOT a fracture, this looks more like 11752, 12001.


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## sphillips79 (Feb 24, 2010)

I would bill 11760, 12001, I would not bill an open reduction, nor would I bill 11752 he did not remove the tuft of the distal phalanx, he only reduced it. So in this case I agree with the provider.


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