Coding Challenge / General

Correctly Code Crush Injury of Hand

Question:
We have a patient who had a severe crush injury of the left hand which led to a comminuted fracture of the left 3rd and 5th metacarpals with an intra-articular fracture of the proximal phalanx of the left index finger.  The physician’s documentation indicates the following:

  • There was also a soft tissue defect over the left proximal interphalangeal (PIP) joint of the middle finger.  After taking samples for culture, the wounds were meticulously débrided and curetted.
  • Bony structures were evident over the 3rd metacarpal as well as on the PIP of the middle finger where the defect was about 3-1/2 to 2-1/2 inches. The area of the dorsum of the PIP joint of the left middle finger was about ¾ inch x ¾ inch.
  • Debridement and irrigation was done using 6 liters of saline with the gravity Patzakis technique and 1 liter of antibiotic.
  • After the wound was washed, X-rays were taken to confirm the fractures though no attempt was made to reduce any fractures because of the severe contamination.  A wound-VAC was planned for the dorsum of the left hand at the PIP joint of the left small finger.

Would I report 11043 and 97605 with ICD-9 682.4 and 681.00?

-North Carolina Subscriber

Answer:
The correct codes in this situation would be 11010 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and
subcutaneous tissues), 11011 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscle), or 11012 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (e.g., excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and...

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June 17, 2011
Hot Coding Topics

Medical Coders: Here’s Your 411 on Femoral Head Resurfacing

Understand what FHR involves and when patients benefit.

An initial femoral head resurfacing (FHR) procedure involves only the femoral head and not the acetabular socket of the hip joint. The surgeon mills the femoral head and implants a metal hemisphere over the bone that exactly matches the size of the original femoral head.

FHR helps “buy time” for patients whose disease or degree of progression doesn’t merit total hip replacement (27130, Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft).

This is especially true for younger patients because femoral head resurfacing preserves more bone stock for possible later revisions.

Judy Larson, CPC, billing manager for Rockford Orthopedic Associates in Rockford, Ill., shares a few advantages of choosing FHR:

  • Patients are likely to recover a natural gait
  • The larger size of the implant (ball) reduces the risk of dislocation
  • The femoral head/canal is preserved
  • There’s no associated femoral bone loss with future revision
  • Patients can experience less thigh pain because hip stress transfers in a natural way along the femoral canal and through the femur’s head and neck.

The metal head used during FHR will wear out the socket over time, however, and the patient will need total hip replacement.

Once the patient reaches the point of total hip replacement you’ll code the new procedure as a conversion with 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft), says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network.

@ Orthopedic Coding Alert. Editor: Leigh DeLozier, CPC

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June 1, 2010
Coding Challenge

Check for Fracture Diagnosis Before Coding Repair

Don’t code a closed fracture treatment code without more information.

Question: Our orthopedist saw a patient in the emergency department for a gunshot wound and diagnosed a metacarpal fracture. He irrigated the site and removed a foreign body. Can we...

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April 22, 2010
Hot Coding Topics / modifier 54 / modifier 57

Fracture Care Coding: Mark Manipulation, Make $100+ More Per Encounter

No maybes here: Answer this question wrong and you will code incorrectly. When your ED physician performs fracture care for a patient, be ready to pounce on evidence of manipulation, as CPT often breaks fracture care codes along the manipulation line. The $kinny: Let’s say the physician performs closed treatment on a fractured collarbone; if she uses [...] Related articles:

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October 12, 2009