Desperate Denise
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Hi foot and ankle coders.
I would be so grateful for your help coding htis procedure. My boss uses code 14040 and I am not convinced this is right.
Please help with CPT code
THANK YOU SO MUCH!!!
POSTOPERATIVE DIAGNOSES:
1. Ingrown toenail, right lateral hallux.
2. Exostosis, right hallux.
OPERATION PERFORMED:
1. Partial nail avulsion, right hallux.
2. Exostectomy with a skin flap, right hallux.
INDICATIONS FOR PROCEDURE presents to Operating Room
with a painful hallux nail of the right foot, which could not be resolved
with conservative modalities.
DESCRIPTION OF PROCEDURE: The patient was brought in the operating room,
placed on the operating table in supine position. The patient's right foot
was marked in the preoperative area. A timeout was performed at this time.
Following IV sedation, a 11 mL of a 1:1 mixture of 0.5% Marcaine plain and
1% lidocaine plain was injected into the patient's right foot in a digital
nerve block fashion. The patient's right foot was prepped, scrubbed and
draped in the typical aseptic technique. The Penrose drain tourniquet was
used a noninvasive tourniquet to aid in visualization of the working area.
PARTIAL NAIL AVULSION, RIGHT HALLUX:
Attention was directed to the right lateral hallux border where a Freer
instrument was used to penetrate the eponychium. The lateral nail border
was clipped with an English anvil nail splitter. Then the hemostat was
placed on the border of the nail, rotated towards the center of the nail,
which allowed the lateral of nail border to the exposed and removed.
EXOSTECTOMY WITH SKIN FLAP, RIGHT HALLUX:
Attention was then directed to the dorsolateral aspect of the right hallux
nail bed proximal toward the nail which was just removed. A 2-cm hockey
stick shaped incision was proximal to the lateral nail border with the
transverse extension going laterally at the proximal edge. Using sharp
dissection, the skin was resected. Prominent exostosis of the underlying
bone was noted. A rongeur was used to resect and clean up the prominence.
The nail matrix was dissected and removed. Bone was sent off for specimen.
The skin edges were approximated with 4-0 nylon suture in a simple
interrupted technique.
A dressing was applied consisting of Betadine-soaked Adaptic, 4 x 4 gauze,
Kling, Kerlix and Ace wrap. Postoperative care was started in the
Operating Room. The patient tolerated the procedure well, had no
complications and was discharged home with vital signs stable and vascular
status intact to the right foot. The patient was given postoperative
I would be so grateful for your help coding htis procedure. My boss uses code 14040 and I am not convinced this is right.
Please help with CPT code
THANK YOU SO MUCH!!!
POSTOPERATIVE DIAGNOSES:
1. Ingrown toenail, right lateral hallux.
2. Exostosis, right hallux.
OPERATION PERFORMED:
1. Partial nail avulsion, right hallux.
2. Exostectomy with a skin flap, right hallux.
INDICATIONS FOR PROCEDURE presents to Operating Room
with a painful hallux nail of the right foot, which could not be resolved
with conservative modalities.
DESCRIPTION OF PROCEDURE: The patient was brought in the operating room,
placed on the operating table in supine position. The patient's right foot
was marked in the preoperative area. A timeout was performed at this time.
Following IV sedation, a 11 mL of a 1:1 mixture of 0.5% Marcaine plain and
1% lidocaine plain was injected into the patient's right foot in a digital
nerve block fashion. The patient's right foot was prepped, scrubbed and
draped in the typical aseptic technique. The Penrose drain tourniquet was
used a noninvasive tourniquet to aid in visualization of the working area.
PARTIAL NAIL AVULSION, RIGHT HALLUX:
Attention was directed to the right lateral hallux border where a Freer
instrument was used to penetrate the eponychium. The lateral nail border
was clipped with an English anvil nail splitter. Then the hemostat was
placed on the border of the nail, rotated towards the center of the nail,
which allowed the lateral of nail border to the exposed and removed.
EXOSTECTOMY WITH SKIN FLAP, RIGHT HALLUX:
Attention was then directed to the dorsolateral aspect of the right hallux
nail bed proximal toward the nail which was just removed. A 2-cm hockey
stick shaped incision was proximal to the lateral nail border with the
transverse extension going laterally at the proximal edge. Using sharp
dissection, the skin was resected. Prominent exostosis of the underlying
bone was noted. A rongeur was used to resect and clean up the prominence.
The nail matrix was dissected and removed. Bone was sent off for specimen.
The skin edges were approximated with 4-0 nylon suture in a simple
interrupted technique.
A dressing was applied consisting of Betadine-soaked Adaptic, 4 x 4 gauze,
Kling, Kerlix and Ace wrap. Postoperative care was started in the
Operating Room. The patient tolerated the procedure well, had no
complications and was discharged home with vital signs stable and vascular
status intact to the right foot. The patient was given postoperative