Q: How do you code a “completion amputation”, where a traumatic amputation of the finger is cut back further and then closed up?
A: It depends on how much tissue was removed, at what level, and how it’s documented. If a rongeur was used to just smooth off the bone and the skin closed over it, an Excision bone and Repair skin may be the best bet. If there is a documented “amputation”, and there was a formal shortening of the bone, and especially with cutting back tendons and nerves, followed by skin closure with flaps or otherwise, you’re looking more at a Detachment at whatever level it was done, like low, mid, high finger. And of course not at the level of the injury, but of the re-amputation, which is often at the next most proximal IP joint. There is a Coding Clinic which describes this scenario.
Q: How would you code a high-pressure injection injury washout and debridement of the finger?
A: This is an injury where a paint gun or pressure washer actually cuts a hole in the skin, unfortunately often the hand, which can require opening up the tissue to clean out the substance and any damaged tissue. How to code it depends on the circumstances. If there is paint or oil in the tissues, it would make sense to code a Drainage of whatever tissue layer was involved, probably subcutaneous and fascia of hand. If it was water it would probably have been absorbed so the goal of the procedure would be debridement, so Excision of whatever tissue, again probably subcutaneous. Some instances may have both of these PCS root operations.
Q: What is a filleted finger flap and how would you code it?
A: A filleted finger flap is a salvage procedure to use the skin and soft tissue of a badly damaged digit to cover some adjacent tissue wound instead of just throwing away the skin. What’s done is what you would expect from a fillet – the bones are taken out. Then the remaining skin and subcutaneous tissue would be used as a pedicled flap nearby. With that tissue still attached, which is the preferred, we’re looking at a PCS Transfer. And the body part would be either subcutaneous tissue of hand or possibly skin of hand depending on the depth of the tissue as documented. Now this could be a free flap in which case it becomes a Replacement of hand skin or subcutaneous tissue depending on the tissue depth, and the PCS device would of course be autologous substitute.
**The coding information and guidance in this post are valid at the time of publishing. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Ed O'Beirne, CCS, CHDA, CHPS, CDIP, PA, MHS
Director of Clinical Integration
Ed has been in healthcare his entire career with 15 years as a clinician and 11 years in a variety of HIM coding related roles. After 4 years as a respiratory therapist and 11 years as an emergency medicine Physician Assistant, the fascination with reading, analyzing, and translating medical documentation overcame his desire to perform patient care. For a guy with a habit for reading the Encyclopedia Brittanica, the Merck Manual, and medical records just for fun, HIM became a natural fit.
Documentation and coding audits are firmly in Ed’s skillset but educating coders is what really makes him tick. He is known for effectively integrating anatomy, physiology, pathophysiology, medicine, and detailed procedural descriptions into his coding education in all forms.