ED Coding and Reimbursement Alert

Answer: You should not report the code for amputation of finger/phalanx, CPT® 26951  (Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure). Most of the amputation occurred before the patient arrived at the hospital, and your physician just cleaned up the amputation. Though the code bundles the closure, it doesn't accurately fit your scenario.

This scenario calls for a debridement and a simple closure code instead. Report the debridement as 11044  (Debridement, bone [includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed]; first 20 sq cm or less) because your physician definitely debrided not only the skin but also the muscle and bone. He then also closed the defect, so you should add a simple laceration code from the 1200x series to cover the extra work of the closure. In this case, use 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.6 cm to 7.5 cm).

The debridement-plus-closure code assignment is very safe from a coding perspective, but reporting a single, appropriate code might increase payment advantages. Depending on documentation, consider using the complex laceration code 13132 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm).