I am in need of some advice regarding a procedure my doctor performed. She wants to bill CPT 26951 and I disagree. I am not 100% sure on what she should bill, maybe complex repair...
Any advice would be greatly appreciated.
X-rays show an amputation of a portion of the tuft of the index finger.
Procedures
After numbing him up with a digital block with 1% Xylocaine with EPINEPHrine mixed 1:1 with 0.25% Marcaine plain, one could see that he had pretty much a transverse amputation through the tuft. There was some bone exposed.
I discussed with him that allowing some secondary healing would likely give him a better fingertip than a VY advancement.
He understands and has given consent. He was then prepped and draped in the usual sterile fashion. A finger tournicot was used to allow visualization. A 15 blade was used to elevate the soft tissue away from the phalanx. The phalanx was then smoothed with rongeur, taking multiple small bites to smooth the contour. Skin was closed where possible on the ulnar portion. A suture was placed through the subcutaneous tissue and placed through the fingernail to cover a portion of the bone. The nail bed was then released from the fingernail to allow further soft tissue collapse over the end of the bone.
Remaining closure was done with interrupted 5-0 chromic sutures. The nail was trimmed back. The tournicot was released.
He was dressed with Adaptic, Bacitracin, 2 x 2's, Kling, and he was given prescription for Keflex 500 mg 3 times a day for 5 days and Percocet 5/325, 40 tablets, 1-2 orally every 4 hours as needed for pain.
Thank you for your help on this...
Any advice would be greatly appreciated.
X-rays show an amputation of a portion of the tuft of the index finger.
Procedures
After numbing him up with a digital block with 1% Xylocaine with EPINEPHrine mixed 1:1 with 0.25% Marcaine plain, one could see that he had pretty much a transverse amputation through the tuft. There was some bone exposed.
I discussed with him that allowing some secondary healing would likely give him a better fingertip than a VY advancement.
He understands and has given consent. He was then prepped and draped in the usual sterile fashion. A finger tournicot was used to allow visualization. A 15 blade was used to elevate the soft tissue away from the phalanx. The phalanx was then smoothed with rongeur, taking multiple small bites to smooth the contour. Skin was closed where possible on the ulnar portion. A suture was placed through the subcutaneous tissue and placed through the fingernail to cover a portion of the bone. The nail bed was then released from the fingernail to allow further soft tissue collapse over the end of the bone.
Remaining closure was done with interrupted 5-0 chromic sutures. The nail was trimmed back. The tournicot was released.
He was dressed with Adaptic, Bacitracin, 2 x 2's, Kling, and he was given prescription for Keflex 500 mg 3 times a day for 5 days and Percocet 5/325, 40 tablets, 1-2 orally every 4 hours as needed for pain.
Thank you for your help on this...