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Coding for finger amputation

HCPro Coder Connection, April 7, 2004

Operative Report

 

Operation: Revision of amputation of the right index finger and ring finger.

 

Anesthesia: Local with intravenous sedation.

 

Preoperative diagnosis: Scleroderma, failed right index finger and ring finger amputations.

 

Postoperative diagnosis: Scleroderma, failed right index finger and ring finger amputations.

 

Operative indications: The patient is a 38-year-old female with a history of scleroderma. In the past, she had undergone previous amputations of the right index finger and ring finger. Over the years, her bone has eroded to the point where there was exposed bone to the tips of the amputated sites and continuous drainage. It was felt that she would benefit from excision of additional bone with a primary closure. The operative risks and benefits of the procedure were discussed at length with the patient, including but not limited to injury to skin, soft tissues, muscles, bone, failure of the operation, the need for future operations, and anesthetic risks and neurovascular injury. She wished to proceed.

 

Operative procedure: Following proper consent and identification, the patient was taken to the operating room. Following induction of a local anesthetic at the wrist level as well as the metacarpophalangeal joint level, the patient's right arm was prepared and draped in the standard sterile fashion. A pneumatic tourniquet was applied, but it was never inflated.

 

Using a finger tourniquet on the right ring finger, an elliptiform incision approximately 1.5 cm long was made over the area of exposed bone. This was carried down to the volar and dorsal sides of the bone. The bone was identified and cleaned of its soft tissue attachments. At this point, the interphalangeal joint was easily found, and a joint disarticulation was completed. The wound was thoroughly irrigated.

 

The tourniquet was removed and a good bleeding bed was easily found. There was an area that continued to be blanched, and following placement of a warm sponge, it quickly blushed with a good blood flow. Attention was drawn to the index finger. Again using the elliptiform incision across, approximately 1.5 cm in length, this was carried down to the bone. The bone was again cleared of its soft tissue attachments. Two nubs of bone were clearly visible, and these were removed with the rongeur. The inside of the bone appeared to have what looked like sequestrum, and this was carefully curetted out. The wound was carefully irrigated.

 

Both wounds were closed using a #4-0 Ethilon suture in an interrupted manner. A dry occlusive dressing was placed, and the patient was taken to the post-anesthetic care unit in stable condition. The patient tolerated the procedure well. 

 

Questions: 

 

1. What CPT code or codes must be used for this procedure?

 

2. What two modifiers are required for this case?

 

Answers:  

 

1. You must use CPT code 26951, "Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure" for this procedure.

 

2. To receive reimbursement for both fingers, you must use modifier F6, "right hand, second digit," and modifier F8, "right hand, fourth digit."

 

This week's HCProCoder Connection was adapted from The Modifier Clinic: A Guide to Hospital Outpatient Issues. Go to http://www.hcmarketplace.com/Prod.cfm?id=1527 or call HCPro's Customer Service Department at 800/650-6867.