Orthopedic Coding Alert

Question: In a patient who was injured by a power saw, our surgeon diagnosed a laceration with partial loss of soft tissue in the left index pulp, a simple laceration of pulp of left ring finger, and a volar laceration through middle finger DIP crease with near amputation with open joint.

The procedures performed included the following:

1. Sharp debridement, skin, left index finger.

2. Sharp irrigation and debridement, skin and bone, left middle finger with DIP fusion, FDP repair and micro repair, ulnar digital nerve, intermediate repair, 2 cm wound. 

3. Irrigation and sharp debridement, skin and subcutaneous tissue, ring finger laceration; simple repair, left ring finger laceration (1.5 cm).

How do we report this?
 
North Carolina Subscriber

Answer:  Since your surgeon is doing a FDP repair, you report code 26370 (Repair or advancement of profundus tendon, with intact superficialis tendon; primary, each tendon). For the DIP fusion in the left middle finger, you report 26860 (Arthrodesis, interphalangeal joint, with or without internal fixation). For repair of ulnar digital nerve, you report 64831 (Suture of digital nerve, hand or foot; 1 nerve). For the simple repair of left finger 1.5 cm laceration, you report 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less). Debridement is inclusive in repair of laceration and you do not separately report for this. If an operating microscope is used, you also report +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]). For the index finger debridement, you can report 97597 (Debridement [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm], including topical application[s], wound assessment, use of a whirlpool, when performed and instruction[s] for ongoing care, per session, total wound[s] surface area; first 20 sq cm or less).