Orthopedic Coding Alert

Question: We have a patient who had a severe crush injury of the left hand, which led to open comminuted fractures of the left 3rd and 5th metacarpal necks with an intra-articular fracture of the proximal phalanx of the left index finger. The physician’s documentation indicates the following:

There was also a soft tissue defect over the left proximal interphalangeal (PIP) joint of the middle finger. After taking samples for culture, the wounds were meticulously débrided and curetted. Bony structures were evident over the 3rd metacarpal as well as on the PIP of the middle finger where the defect was about 3-1/2 to 2-1/2 inches. The open area over the dorsum of the PIP joint of the left middle finger was about ¾ inch x ¾ inch. Debridement and irrigation was done using 6 liters of saline with the gravity Patzakis technique and 1 liter of antibiotic solution. After the wound was washed, X-rays were taken to confirm the fractures though no attempt was made to reduce any fractures because of the severe contamination. A wound-VAC was planned for the dorsum of the left hand at the PIP joint of the left small finger.

Would I report 11043 and 97605 with S64.22XA, S62.333B, S62.337B, S62.611B, S61.223B?

North Carolina Subscriber

Answer: The correct codes in this situation would be 11010 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation [eg, excisional debridement]; skin and subcutaneous tissues), 11011 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation [eg, excisional debridement]; skin, subcutaneous tissue, muscle fascia, and muscle), or 11012 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation [e.g., excisional debridement]; skin, subcutaneous tissue, muscle fascia, muscle, and bone), depending upon the depth of tissues debrided.

You need to query the physician to differentiate which wound vacuum code to report. You would either report 97605 (Negative pressure wound therapy [eg, vacuum assisted drainage collection], utilizing durable medical equipment [DME], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session; total wound[s] surface area less than or equal to 50 square centimeters) or 97607 (Negative pressure wound therapy, [eg, vacuum assisted drainage collection], utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application[s], wound assessment, and instructions for ongoing care, per session; total wound[s] surface area less than or equal to 50 square centimeters) for the wound care.

In addition, you are correct about your ICD-10 codes. To indicate the areas of injury, you should report:

• S62.333B (Displaced fracture of neck of third metacarpal bone, left hand, initial encounter for open fracture),
• S62.337B (Displaced fracture of neck of fifth metacarpal bone, left hand, initial encounter for open fracture),
• S62.611B (Displaced fracture of proximal phalanx of left index finger, initial encounter for open fracture), and 
• S67.22XA (Crushing injury of left hand, initial encounter).