Orthopedic Coding Alert

Question: We have a patient who had a severe crush injury of the left hand which led to a comminuted fracture of the left 3rd and 5th metacarpals 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 area of 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. 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 ICD-9 682.4 and 681.00?

North Carolina Subscriber

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. Your would also report 97605 (Negative pressure wound therapy (eg, vacuum assisted drainage collection), 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) for the wound care.

In addition, to indicate the areas of injury, report ICD-9 codes 815.14 (Open fracture of neck of metacarpal bone(s)), 816.11 (Open fracture of middle or proximal phalanx or phalanges of hand). Include codes 882.1 (Open wound of hand except fingers alone complicated) or 882.2 (Open wound of hand except fingers alone with tendon involvement) depending upon tendon involvement. Code 882.2 seems more appropriate as tendon involvement seems evident in description. Lastly, include 927.20 (Crushing injury of hand(s)) for crush injury of hand.