Orthopedic coding: Code Crush Injury of Hand the Right Way

Published: 04th May 2011
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There is this patient who had a severe crush injury of the left hand; this 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 doctor's documentation points to the following:



Also there was a soft tissue defect over the left proximal interphalangeal (PIP) joint of the middle finger. The wounds were meticulously débrided and curetted post taking samples for culture. Bony structures were seen 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 around ¾ inch x ¾ inch. Debridement and irrigation was done utilizing six liters of saline with the gravity Patzakis technique and one liter of antibiotic. Once the wound was washed, X-rays were taken to corroborate the fractures though no attempt was made to reduce any fractures owing to the severe contamination. A wound-VAC was planned for the dorsum of the left hand at the PIP joint of the left small finger.



Here would you report 11043 and 97605 with ICD-9 682.4 and 681.00?



The proper 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 (for instance, 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 (for instance, 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 (for instance excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone), depending upon the depth of tissues debrided. You would also code 97605 (Negative pressure wound therapy (example vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square cm) for the wound care.



Apart from this, to indicate the areas of injury, code ICD-9 codes 815.14 (Open fracture of neck of metacarpal bone(s)), 816.11 (Open fracture of middle or proximal phalanx or phalanges of hand). Cover codes 882.1 (Open wound of hand except fingers alone complicated) or 882.2 (Open wound of hand except fingers alone with tendon involvement) depending upon tendon involvement. 882.2 seems more proper as tendon involvement seems evident in description. In the end, include 927.20 (Crushing injury of hand(s)) for crush injury of hand.




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