D.R.
Networker
My provider wants to use +64787 for the transection of the digital nerve with deep tissue embedment along w/ amputation of distal phalanx. As you know 64787 is an add on code for excision of neuroma(s)codes 64774-64786. The were no neuromas excised. Would the digital nerve transection w/ deep tissue embedment be a component of the amputation code 26952? Thanks!!
Decision was made to proceed with amputation of the remnant distal phalanx. The dorsal incision was extended distally about the radial and ulnar margins and carried to the pulp, preserving as much volar soft tissue as possible. The remaining extensor tendon and collateral ligaments about the distal interphalangeal joint were divided and the remnant distal phalanx bone fragment was sharply dissected from the volar soft tissue. The flexor tendon was identified and sharply divided to allow for retraction. Blunt dissection was carried out along the volar flap, and ulnar neurovascular bundle was identified. The digital nerve was transected under traction and allowed to retract. The radial neurovascular bundle was not identified within the volar flap. The bone of the middle phalanx was then debrided using a rongeur until bleeding tissue was identified. This resulted in a shortening to the level of the mid-middle phalanx. The distal phalanx and bony fragments of the middle phalanx were passed off the field and sent to pathology and microbiology. The digital nerves on the both sides were confirmed to be shortened enough, away from the tip skin and was embedded close to bone with fascia and tendinous tissues.
Decision was made to proceed with amputation of the remnant distal phalanx. The dorsal incision was extended distally about the radial and ulnar margins and carried to the pulp, preserving as much volar soft tissue as possible. The remaining extensor tendon and collateral ligaments about the distal interphalangeal joint were divided and the remnant distal phalanx bone fragment was sharply dissected from the volar soft tissue. The flexor tendon was identified and sharply divided to allow for retraction. Blunt dissection was carried out along the volar flap, and ulnar neurovascular bundle was identified. The digital nerve was transected under traction and allowed to retract. The radial neurovascular bundle was not identified within the volar flap. The bone of the middle phalanx was then debrided using a rongeur until bleeding tissue was identified. This resulted in a shortening to the level of the mid-middle phalanx. The distal phalanx and bony fragments of the middle phalanx were passed off the field and sent to pathology and microbiology. The digital nerves on the both sides were confirmed to be shortened enough, away from the tip skin and was embedded close to bone with fascia and tendinous tissues.