Wiki Thumb tip amputation with flap closure

[abaer01]

I'm struggling to find the appropriate code for the closure. Op note below:

"We obtained fluroscopic imaging verifying the position of most prominent bone and debrided that back to stable edges. This was comminuted and fractured. We did not remove any absolute normal bone. Once we had a stable edge of the bone there, we created a flap of skin from the volar tissue and flipped it over the top after removing the germinal matrix. Excess skin was removed as well as some dog ears. Once we were satisfied with that, we removed a finger tourniquet and noted good capillary refill. A finger dressing was applied..."

I've got the debridement, but how would you code the closure?

Thank you!!

 

[fish4codes]

Not sure if I am understanding the OP note entirely, if it was an amputation (or any removal of bone therein) and you did a flap closure you would use 26952, If it was a debridement of an OPEN fracture, codes 11012 and 14040. Hope I didn't make this more confusing...

 

[abaer01]

Not sure if I am understanding the OP note entirely, if it was an amputation (or any removal of bone therein) and you did a flap closure you would use 26952, If it was a debridement of an OPEN fracture, codes 11012 and 14040. Hope I didn't make this more confusing...

The patient caught their thumb in a table saw and partially amputated the thumb above the DIP joint. My doc didn't amputate the rest of the thumb at the joint, but referred to the procedure as a partial amputation of the thumb. I would say he debrided the open fracture and closed the wound with a flap, so 11012 and 14040 would be the most appropriate. My concern is that the 14040 will be denied for documentation does not support since there are no measurements or mention of closing of the secondary defect. If it gets denied though, I'll have him addend the note.

Thank you! Didn't make it more confusing at all. I do appreciate the response .