Hi,
I am having issues with a provider insisting on billing 11044 with 26952. He says because it was a traumatic partial amputation of the right index finger, that he can bill for the debridement with a modifier 59. My supervisor has asked me to do some research to present to this provider as to why we Cannot bill 11044. If anyone can help me out with this, it is greatly appreciated. Op note below.
I am having issues with a provider insisting on billing 11044 with 26952. He says because it was a traumatic partial amputation of the right index finger, that he can bill for the debridement with a modifier 59. My supervisor has asked me to do some research to present to this provider as to why we Cannot bill 11044. If anyone can help me out with this, it is greatly appreciated. Op note below.
Pre-Op Diagnosis: Right index finger partial amputation with nailbed injury and exposed bone index finger
Post-Op Diagnosis: Same
Procedure:
Right I&D open injury including bony debridement
Right index finger nailbed repair
Right revision amputation index finger
Right full-thickness skin graft 2 cm index fingerPost-Op Diagnosis: Same
Procedure:
Right I&D open injury including bony debridement
Right index finger nailbed repair
Right revision amputation index finger
Detailed Description of Procedure:
Brief clinical note:
The patient presents with a right index finger human bite that tore off the end of the finger. This can involve the nailbed the bone and the soft tissue to some extent. The bone is extremely exposed is appreciated clinically. The patient presents for definitive treatment. Understands the Intra-Op residual made. He understands will shorten the finger. Based on what we do will be amputation of the DIP joint level or perhaps further. If we can do some reconstructive efforts of the nail and the skin we will certainly do so to maintain functionality and length. Patient is comfortable with the plan the patient is consented and marked. He understands implications of the procedure.
Operative note:
Final timeout is done with the operative team after the areas prepped and rate in usual manner. Esmarch exsanguination is done and tourniquet inflated. The areas inspected which unfortunately demonstrates a very traumatic wound. The patient has complete tissue loss distally and involves the entirety of the pulp and the distal aspect of the finger. The patient has exposed bone. The patient's cuticle is intact approximately but the radial side is completely gone. The patient does have a little proximal portion of the nailbed but the distal part is gone. The portion that remains has a longitudinal split in it as well. The bone is extremely exposed. His FDP is intact his terminal extensor appears to be intact. First thing this done the area is copiously aided irrigated out and washed out. This is done to the level of bone with mechanical debridement. This is aided also by a little bit of shortening of the bone. This is done with irrisept solution in the normal routine and then irrigated out with a saline. This completes the I&D portion of the procedure.
Attention is now toward the nail. The distal aspect of the bone was removed back to where the nailbed distally is intact. The vertical split is then repaired with multiple fast-absorbing sutures. This completes the nailbed repair. This point time decisions have to be made in regards to coverage.
After discussion to maintain length and cover the bone we decided to do a advancement locally with the tissues with absorbable suture followed by full-thickness skin graft. This would maintain length the best possible and much better than what would be the case with a V-Y plasty in the cyst situation. For getting coverage over the bone with a soft tissue this left a defect of about 1.5 to 2 cm which then covered with a full-thickness skin graft.
Full-thickness skin graft was carried out from the ulnar border of the wrist. Removed approximately 2.5 by centimeter and a half in width. This was then pie shaped and for obtain full coverage of the index finger the ends were cut and the main portion of the graft was then utilized directly over the open site. This was sewed down to the dorsal aspect of the bone including the nailbed which was and nail. This fixation was done circumferentially with 5-0 nylon. Of note the only thing we used that was not with the patient was his nail in it we trimmed this out to maintain the cuticle and also give us some think better than his tissue that would allow us to do so in the graft and the tissue to. The site was closed with 4-0 nylon. Completing the case.
Brief clinical note:
The patient presents with a right index finger human bite that tore off the end of the finger. This can involve the nailbed the bone and the soft tissue to some extent. The bone is extremely exposed is appreciated clinically. The patient presents for definitive treatment. Understands the Intra-Op residual made. He understands will shorten the finger. Based on what we do will be amputation of the DIP joint level or perhaps further. If we can do some reconstructive efforts of the nail and the skin we will certainly do so to maintain functionality and length. Patient is comfortable with the plan the patient is consented and marked. He understands implications of the procedure.
Operative note:
Final timeout is done with the operative team after the areas prepped and rate in usual manner. Esmarch exsanguination is done and tourniquet inflated. The areas inspected which unfortunately demonstrates a very traumatic wound. The patient has complete tissue loss distally and involves the entirety of the pulp and the distal aspect of the finger. The patient has exposed bone. The patient's cuticle is intact approximately but the radial side is completely gone. The patient does have a little proximal portion of the nailbed but the distal part is gone. The portion that remains has a longitudinal split in it as well. The bone is extremely exposed. His FDP is intact his terminal extensor appears to be intact. First thing this done the area is copiously aided irrigated out and washed out. This is done to the level of bone with mechanical debridement. This is aided also by a little bit of shortening of the bone. This is done with irrisept solution in the normal routine and then irrigated out with a saline. This completes the I&D portion of the procedure.
Attention is now toward the nail. The distal aspect of the bone was removed back to where the nailbed distally is intact. The vertical split is then repaired with multiple fast-absorbing sutures. This completes the nailbed repair. This point time decisions have to be made in regards to coverage.
After discussion to maintain length and cover the bone we decided to do a advancement locally with the tissues with absorbable suture followed by full-thickness skin graft. This would maintain length the best possible and much better than what would be the case with a V-Y plasty in the cyst situation. For getting coverage over the bone with a soft tissue this left a defect of about 1.5 to 2 cm which then covered with a full-thickness skin graft.
Full-thickness skin graft was carried out from the ulnar border of the wrist. Removed approximately 2.5 by centimeter and a half in width. This was then pie shaped and for obtain full coverage of the index finger the ends were cut and the main portion of the graft was then utilized directly over the open site. This was sewed down to the dorsal aspect of the bone including the nailbed which was and nail. This fixation was done circumferentially with 5-0 nylon. Of note the only thing we used that was not with the patient was his nail in it we trimmed this out to maintain the cuticle and also give us some think better than his tissue that would allow us to do so in the graft and the tissue to. The site was closed with 4-0 nylon. Completing the case.