# Hand surgery



## RebeccaWoodward* (Feb 19, 2010)

Any thoughts on the CPT codes for this? 

*POSTOPERATIVE DIAGNOSES:*
1.	Left index finger amputation through the distal phalanx with disruption of the flexor digitorum profundus attachment. 
2.	Amputation through the left long fingertip through the distal phalanx 
without evidence of injury to the flexor digitorum profundus. [/U]

*PROCEDURES: *
1.	Irrigation and debridement of left index fingertip with completion of amputation through the distal interphalangeal joint (DIP) joint and repair of the flexor digitorum profundus tendon to the capsule of the 
distal interphalangeal joint (DIP) joint. 
2.	Completion of amputation through the distal interphalangeal joint (DIP) joint, left index finger with Irrigation and debridement. 
3.	Closure of both fingertips with total of 6 cm of wound closure. 

The wounds were evaluated and in order to obtain closure of the fingertips I rongeured the remnant of the distal phalanx of the index and long fingers back through the DIP joint but left the cartilage cap of the middle phalanx intact in each finger. The flexor digitorum profundus tendon was disrupted in the index finger and I was concerned that if this was not repaired that it might provide further impairment in the patient's ability to grip due to retraction of the flexor digitorum profundus into the palm. 

After irrigating each fingertip with a total of 2000 mL of crystalloid with antibiotics using pulsatile lavage, I debrided the end of the flexor digitorum profundus and then sutured it with 3-0 Vicryl suture to the capsule remnant of the DIP joint. 

I then was able to close the skin over each finger with interrupted 2-0 chromic. This gave excellent repair of the skin over each amputated site. I then performed digital blocks of the index and long finger using a total of 16 mL of 1% plain lidocaine. A sterile dressing incorporating the index and long fingers were then applied.


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## khopstein (Feb 19, 2010)

I would look at 26370, 26951 x 2, 13132.  The debridements are included in the amputation completions.


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## RebeccaWoodward* (Feb 23, 2010)

Thank you for your reply.  Honestly, I didn't pick up on the 26370...and you're not the only one to suggest this in addition to 26951 x 2.  Again...Thanks for your input!


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