Orthopedic Coding Alert

Question: When a traumatic fingertip amputation occurs and the physician performs a revision (suturing the piece back onto the finger and repairing the nail bed), what is the proper code? I have been told to use the amputation code as if the physician had amputated the finger or to bill an open fracture treatment code and bill extra for the nail repair or pinch graft if performed.

Donna Bal
Midwest Orthopaedic Surgery Inc., Joplin, Mo.

Answer: Because of the wide variety of potential codes, the proper billing would be based on the exact service performed. But in general terms, if there is a fracture, bill the open fracture code and for the repair of the nail bed (11760, repair of nail bed). If the end of the bone is removed and there is only soft tissue remaining that is repaired, then bill the nail bed repair, grafts or wound repair codes as appropriate. Amputation codes would not be used because there is no amputation being performed.