Orthopedic Coding Alert

Consider the closure method to choose the correct amputation code

If your orthopedic surgeon performs finger amputations in the OR, you-re all too familiar with the 26910-26952 series. But what happens when a patient amputates part of his finger before he arrives at the hospital? We-ll show you how to select the accurate code depending on the surgeon's documentation and the nuances between the amputation codes.

Read the following operative note that one of our subscribers submitted and review our experts- coding recommendations. Scrutinize the Op Report The basics: A 37-year-old male patient accidentally injured the fourth and fifth fingers of his left hand in a chain-and-sprocket configuration. The machine amputated the tip of the patient's fifth finger at the mid-nail level  and left an additional four centimeters of mangled finger and bone below the amputation. The patient also had minor lacerations over the dip joint volarly at the fourth finger.
 
Procedure: The surgeon administered a Marcaine block and sterilely prepped the fourth and fifth fingers. Using a Penrose drain for a tourniquet about the base of the finger, the surgeon amputated the mangled portion of the finger and sharply debrided the injury at the amputation site, including the bone, with a rongeur.

The surgeon carried out sterile betadine and saline irrigation, then created a V-Y flap to cover the remainder of the finger and sutured it with 5-0 nylon. The surgeon then cleansed the fourth finger with saline and betadine and used single 5-0 nylon to repair the less-than-half-centimeter laceration.

Problem: -Our surgeon wants to bill 14040 and 26765 for this, but another physician in our practice disagrees,- the coder tells Orthopedic Coding Alert. Step 1. Report Amputation, Wound Care We shared the subscriber's operative note with our coding experts: Thomas W. Wolff, MD; Barbara Spaulding, CPC; Tamra L. Avis, CPC; Donna Clemmons; and Kari Wood of Kleinert, Kutz and Associates Hand Care Center in Louisville, Ky. The Kleinert, Kutz team offers the following advice for coding the operative note:

The practice should report 26952-F4 (Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with local advancement flaps [V-Y, hood]; Left hand, fifth digit) to represent the surgeon's work amputating the mangled finger, incising the overlying skin and dissecting the tissues to the bone.

She removed the bone with the rongeur and closed the injury with a V-Y flap closure, which warrants 26952. Link the procedure to the ICD-9 code 886.0 (Traumatic amputation of other finger[s] [complete] [partial]; without mention of complication).

Note: If the surgeon had not created the V-Y flap but had instead used direct closure, you would have reported 26951 (... with direct closure) instead.

To represent the surgeon's simple wound repair to the fourth finger, the [...]