Orthopedic Coding Alert

Question: In a patient who was diagnosed with a finger infection ten days after open reduction and percutaneous pinning of right middle finger distal phalanx open fracture, our surgeon did the following procedures:

1. Irrigation and debridement of right middle fingertip infection, including debridement down to bone.
2. Hardware removal, right middle finger, including removal of K-wire.
3. Nail bed repair.
4. Right middle finger digital block for intraoperative and postoperative analgesia.

How do we report this?

Rhode Island Subscriber

Answer: You report codes 20670 (Removal of implant; superficial [e.g., buried wire, pin or rod [separate procedure]) 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]) F7 for the removal of hardware in the right middle finger, depending upon whether the hardware was superficial or deep. In most instances, pins in the finger are superficial and pretty easy to remove, particularly in the face of an infection. The same code covers the removal of K wire too. For nail bed repair, you report code 11760 (Repair of nail bed).

Irrigation and debridement of right middle fingertip infection, including debridement down to bone is an inclusive procedure to hardware removal for the same finger. You will not separately report for analgesia here.

You also report the diagnosis codes 996.67 (Infection and inflammatory reaction due to other internal orthopedic device implant and graft) for the finger infection and 905.2 (Late effect of fracture of upper extremities) to specify that the infection was a consequence to the fracture.