Wiki Dx for Partial Traumatic Amputation w/ Nail Deformity?

cclarson

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Hello,

The doctor performed an amputation revision for a traumatic amputation that occurred in May w/ a nail deformity which was caused by the amputation. Would I code this as S68.621A? Would that also encompass the nail deformity or would I need another dx code for that Dx?

Here is the report:

POSTOPERATIVE DIAGNOSIS:

Painful left index finger amputation with nail deformity.

OPERATION PERFORMED:
Left index finger revision of amputation.

INDICATIONS FOR PROCEDURE:
The patient is an 82-year-old male with painful left index finger amputation. His nail has a significant deformity. He is taken to the operating room today for surgical revision. I have discussed the surgery with him, the risks. He understands and would like to proceed.

DESCRIPTION OF PROCEDURE:
The patient was taken to the operating room and placed in the supine position on the operating room table. IV sedation was administered. I next administered a digital block at the base of left index finger. The left upper extremity was prepped and draped in the usual sterile manner. A Tournicot was applied.

First I excised the tissue around the nail deformity. I lifted up flaps so that the entire nailbed including all the germinal matrix could be excised. This was done which included this nail deformity. I then took a rongeur and took off some of the distal phalanx and smoothed it down with a rasp. The wound was then washed out vigorously. Skin closed with 5-0 nylon sutures. The Tournicot was removed. Xeroform, 4x4s, and a soft dressing were applied.
 
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I've decided to go with S61.311A for Laceration of Left Index Finger w/ damage to the nail. I believe this code best encompasses the partial amputation with nail deformity.
 
I've decided to go with S61.311A for Laceration of Left Index Finger w/ damage to the nail. I believe this code best encompasses the partial amputation with nail deformity.
The "A" is used until "definitive" treatment is performed, then 'D" during aftercare. Since the definitive treatment was already performed, the amputation performed in May, the "A" is no longer used. Since the patient is still having pain I would say that this is a "Sequela". But this would need to be documented as such to support the code.
 
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