Primary Care Coding Alert

Question: An established patient presents to the FP after an accident; he crushed the tip of his right thumb while putting up folding chairs after a party. After a level-two E/M, the FP used trephination to evacuate a subungual hematoma, according to the notes. How should I code this procedure?

Michigan Subscriber

Answer: On your claim, report the following:

• 11740 (Evacuation of subungual hematoma) for the evacuation (i.e., trephination);

• 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making ...) for the E/M;

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99212 to show that the E/M and evacuation were separate services;

• 923.3 (Contusion of upper limb; finger) appended to 11740 and 99212 to represent the patient's injury; and

• E918 (Caught accidentally in or between objects) appended to 11740 and 99212 to represent the cause of the patient's injury.

Explanation: A subungual hematoma occurs when blood (or other purulent fluid) collects between the nail bed and the fingernail. This injury causes painful pressure to build in the affected digit, which the physician can relieve through trephination (burring of a small hole into the nail) with an electrocautery tool.

Bundle warning: Do not report 11740 if the family physician performs subungual hematoma drainage and either a nail avulsion or nail bed repair for the same patient on the same injury.

The codes for these two procedures -- 11730 (Avulsion of nail plate, partial or complete, simple; single) and 11760 (Repair of nail bed) include hematoma evacuation, when performed, so 11740 will be bundled into either code in most circumstances.