Cheryl Posted Thu 16th of January, 2020 11:28:37 AM
The patient sustained a crush injury resulting in distal phalanx amputation. He was then treated with wound care. Due to slow healing and discomfort, the doctor decided to perform the following: Lunula and nail fold are elevated to expose germinal matrix. The germinal matrix and any remaining sterile matrix are excised in its entirety. Small bone fragments in the distal phalanx remaining distal to the insertion of the extension and flexor tendon are excised as well. This left the distal phalanx remaining with the attachments of the flexion and extensor tendon in order to continue DIP joint motion. A V-Y advancement flap was done for closure. What would be the best code(s) for this surgery? I am wondering if 26952 would be best but I am not sure. Thank you
SuperCoder Answered Fri 17th of January, 2020 02:37:05 AM
Thanks for your question.
Code 26952 suggests that the provider may perform this procedure when the patient already has a partially amputated finger or thumb following traumatic injury. When the patient is appropriately prepped and anesthetized, the provider makes an incision in the skin over the site of interest. He dissects through the subcutaneous tissue and detaches the muscles from the bone. He then ligates the blood vessels. Next, he removes the digital nerves. The purpose of removal of the nerves is to minimize the chances of neuroma formation after amputation. He then makes a cut in the bone at the level of a joint or phalanx and amputates the bone. Finally, he performs closure of the wound by locally advancing the flap from an adjacent site. He performs either V–Y or hood flap closure. In V–Y closure, he incises the flap in the shape of a V and advances it over the wound so that the resulting suture line has the shape of a Y. In hood flap repair, he folds the flap under itself to form a hood, which he uses to cover the wound.
It appears from the provided documentation that the code 26952 can be billed.
Hope this helps.