Desperate Denise
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Podiatry coders!!!
Please help me - I am an orthopedic code who has been thrown into podiatry.
My doctor does this procedure a lot and I do not believe he knows how to code it. He uses 14040 with dx codes 892.0 and 703.0.
Your help will be greatly appreciated.
THANK YOU!!!!!!!
PREOPERATIVE DIAGNOSIS: Right ingrown toenail.
POSTOPERATIVE DIAGNOSIS: Right ingrown toenail.
OPERATION PERFORMED: Right partial nail avulsion of the fibular border of
the right hallux with a rotational flap skin plasty.
INDICATIONS FOR PROCEDURE: A 14-year-old male who presents to the
Operating Room with painful lateral border of his right hallux nail. The
patient has had procedures in the past and continues to have pain and
chronic ingrowing of the nail.
DESCRIPTION OF PROCEDURE: The patient was brought into the Operating Room,
placed on the operating table in the supine position. The patient's right
foot was marked in the preoperative area. A well-padded pneumatic ankle
tourniquet was placed above the patient's right ankle in supramalleolar
region. A timeout was performed at this time. Following general sedation
and intubation, 5 mL of 1:1 mix of 0.5% Marcaine plain and 1% lidocaine
plain was injected into the patient's right foot in a digital nerve block
fashion around the right hallux. The patient's right foot was then
prepped, scrubbed and draped in the typical aseptic technique. Then, at
this time, a Penrose drain toe tourniquet was used to exsanguinate the
right hallux.
RIGHT PARTIAL NAIL AVULSION OF THE FIBULAR BORDER OF THE RIGHT HALLUX WITH
THE ROTATIONAL SKIN PLASTY: Attention was then directed to the lateral
border of the right hallux nail where a chronic ingrowing toenail was
present. At this time, using a Freer elevator, all the skin edges from the
dorsal proximal aspect of the nail with the lateral aspect of the nail and
directly underneath through the nail bed was freed. Then, at this time, an
English anvil was used in the lateral border of the right hallux nail was
excised and sent to Pathology. Following this, a curet was then utilized
to remove any additional tissue. At this time, using #15 blade, a 1 cm
L-shaped incision was made proximal to the nail fold. The incision was
carried down into subcutaneous tissue with sharp dissection techniques. At
this time, using a #64 blade, the matrix was then excised. Using a
rongeur, the bony prominence felt underneath the matrix was excised and
sent for gross pathology. The incision site was then flushed with copious
amounts of sterile saline. The skin was then closed with 4-0 nylon suture
in a simple interrupted technique and the skin was rotated in a _____ type
fashion to bring the skin edges back _____ of the nail was. The Penrose
drain toe tourniquet was then removed. A dressing was applied to the right
foot consisting of Betadine-soaked Adaptic, 4 x 4 inch gauze, Kerlix, and
an Ace wrap. Postoperative care was started in the Operating Room. The
patient tolerated the procedure well, there are no complications, and was
discharged home with vital signs stable and vascular status intact to the
right foot. The patient was given postoperative instructions and told to
Copies to: Mark Rose
Please help me - I am an orthopedic code who has been thrown into podiatry.
My doctor does this procedure a lot and I do not believe he knows how to code it. He uses 14040 with dx codes 892.0 and 703.0.
Your help will be greatly appreciated.
THANK YOU!!!!!!!
PREOPERATIVE DIAGNOSIS: Right ingrown toenail.
POSTOPERATIVE DIAGNOSIS: Right ingrown toenail.
OPERATION PERFORMED: Right partial nail avulsion of the fibular border of
the right hallux with a rotational flap skin plasty.
INDICATIONS FOR PROCEDURE: A 14-year-old male who presents to the
Operating Room with painful lateral border of his right hallux nail. The
patient has had procedures in the past and continues to have pain and
chronic ingrowing of the nail.
DESCRIPTION OF PROCEDURE: The patient was brought into the Operating Room,
placed on the operating table in the supine position. The patient's right
foot was marked in the preoperative area. A well-padded pneumatic ankle
tourniquet was placed above the patient's right ankle in supramalleolar
region. A timeout was performed at this time. Following general sedation
and intubation, 5 mL of 1:1 mix of 0.5% Marcaine plain and 1% lidocaine
plain was injected into the patient's right foot in a digital nerve block
fashion around the right hallux. The patient's right foot was then
prepped, scrubbed and draped in the typical aseptic technique. Then, at
this time, a Penrose drain toe tourniquet was used to exsanguinate the
right hallux.
RIGHT PARTIAL NAIL AVULSION OF THE FIBULAR BORDER OF THE RIGHT HALLUX WITH
THE ROTATIONAL SKIN PLASTY: Attention was then directed to the lateral
border of the right hallux nail where a chronic ingrowing toenail was
present. At this time, using a Freer elevator, all the skin edges from the
dorsal proximal aspect of the nail with the lateral aspect of the nail and
directly underneath through the nail bed was freed. Then, at this time, an
English anvil was used in the lateral border of the right hallux nail was
excised and sent to Pathology. Following this, a curet was then utilized
to remove any additional tissue. At this time, using #15 blade, a 1 cm
L-shaped incision was made proximal to the nail fold. The incision was
carried down into subcutaneous tissue with sharp dissection techniques. At
this time, using a #64 blade, the matrix was then excised. Using a
rongeur, the bony prominence felt underneath the matrix was excised and
sent for gross pathology. The incision site was then flushed with copious
amounts of sterile saline. The skin was then closed with 4-0 nylon suture
in a simple interrupted technique and the skin was rotated in a _____ type
fashion to bring the skin edges back _____ of the nail was. The Penrose
drain toe tourniquet was then removed. A dressing was applied to the right
foot consisting of Betadine-soaked Adaptic, 4 x 4 inch gauze, Kerlix, and
an Ace wrap. Postoperative care was started in the Operating Room. The
patient tolerated the procedure well, there are no complications, and was
discharged home with vital signs stable and vascular status intact to the
right foot. The patient was given postoperative instructions and told to
Copies to: Mark Rose