# Finger nail help



## Justarose (Apr 30, 2009)

Been toiling over this all day yesterday ( well, not all day ! but long enough ...) I really could use some help/advice...thanks! 

POSTOPERATIVE DIAGNOSIS:	Right index finger nailbed deformity with retained foreign material, germinal matrix. .

PROCEDURE PERFORMED:	Excision of sterile and germinal matrix scar, removal of foreign material, right index finger nailbed. 

Consent was obtained.  The patient was taken to the operating room and was given a general anesthetic at her request.  The right upper extremity was then sterilely prepped and draped in a normal fashion with DuraPrep.  The digit was blocked with 0.5% Marcaine for postoperative pain control.  The digit was blocked with 0.5% Marcaine for postoperative pain control.  The nail plate was then removed.  Eponychial incisions were made elevating the proximal eponychial fold.  At this point, the scar in the germinal matrix was excised along the course of the cicatrix.  Once completely excised, this exposed the retained metallic fragments underneath the germinal matrix and embedded into the dorsal aspect of the distal phalanx.  This was copiously irrigated with pulse lavage and then sharp dissection under loupe magnification with a scalpel and Beaver blade to remove the retained material.  Once completely removed, the wounds were irrigated.  We were able to approximate the germinal matrix with a 6-0 plain gut suture and then a Xeroform gauze was applied over the top of the nail bed and then the eponychium repaired with 6-0 plain gut suture.  Dry dressing was applied.  The tourniquet was removed.  The patient was transferred to the recovery room in stable condition. 

This is what I have so far : 13100  F6 for the removal of foreign material nailbed - ??? 

but stuck on : Excision of matrix scar : could this be right ? 
11760 ? 

I don't really think so ; doc wants to bill w/11762 but I don't see a graft anywhere 

How about diagnosis for disformity ? 

Thank you so much !!


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## mbort (Apr 30, 2009)

hmm.. I dont think I would use 13100 as that is not for foreign body removal, thats a complex repair.

I also do not see a graft so 11762 would not be appropriate.

The excision of the scar, to me, was his exposure to the foreign material and therefore would not be coded seperately.

I'm thinking along the lines of 11750 for removal of the nail and matrix.
and perhaps 10120 for the foreign body 

See what you think.


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## martnel (Apr 30, 2009)

I agree with mbort on 11750 and possibly 10120/1, but let me confuse you more (ha): what about 11420/2 for excision of scar?


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## mbort (Apr 30, 2009)

I do not credit for the excision of the scar when its specifically excised through surgical approach.

My thought process:  He had to open the patient to do the surgery anyhow, he just chose to cut through a previous scar and remove it on his way in so this was his surgical approach/exposure to perform the surgery.

I know I have seen something in writing about this somewhere sometime ago but its been embedded in my brain forever so I dont know where.

Does anyone have anything that supports my thought process..or perhaps that coding of this approach is correct?


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## martnel (Apr 30, 2009)

You might be right on this, mbort!  Good thought!


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## Justarose (May 2, 2009)

*thanks!!   :~6)*

I learn more than you can imagine just listening to you all go back and forth with each other - thanks for this community !


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