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ICD-10 Coder's Corner – ICD-10-PCS: Coding Scenario

ICD-10-PCS: Coding Scenario

June 2011 

Preoperative Diagnosis:   Extensive laceration of distal right middle finger with partial amputation of distal phalanx; right index finger laceration

Postoperative Diagnosis: Same

Operation Performed: Open reduction, internal fixation distal phalanx right middle finger with Kirschner wire stabilization; non-extensive debridement of right middle finger laceration; repair of right index finger laceration

Procedure Note:
The patient was taken to the O.R. and prepped & draped in the usual fashion after an axillary block was administered. This injury was sustained by a table saw, and the blade lacerated the dorsal radial aspect of the middle finger at the distal phalangeal phalanx level with penetration into the base of the nail. C-arm fluoroscopy was used to thoroughly evaluate the wound and then the tourniquet was inflated to 275 mm of Mercury after the arm had been exsanguinated. Antibiotic saline solution was used to thoroughly irrigate the wound and all of the devitalized tissue, debris, and foreign bodies were debrided down to subcutaneous tissue. A Kirschner wire of .045 thousandth of an inch in diameter was selected and drilled across the fracture site in the joint to totally stabilize the area. The skin was then carefully closed with interrupted running 5-0 Ethibond suture material.

The remaining laceration on the right index finger was just distal to the insertion of the extensor tendon. It was repaired primarily with no problem.   A large compression dressing with splint immobilization was placed and the patient was taken to the recovery room in stable condition.

Assign the ICD-9-CM and ICD-10-PCS codes for the reportable procedures:


ICD-9-CM procedure codes:
79.34  Open reduction with internal fixation; phalanges of hand
86.28  Non-excisional debridement of wound, infection, or burn
86.59  Closure of skin and subcutaneous tissue of other sites

ICD-10-PCS procedure codes:

0PST04Z Reposition; Upper bones; Finger Phalanx, Right; Open approach; Internal Fixation Device  
 0JDJ0ZZ Extraction; Subcutaneous Tissue & Fascia; Right Hand; Open approach
 0JQJ0ZZ Repair; Subcutaneous Tissue & Fascia; Right Hand; Open approach

Rationale:

Three distinct procedures were performed during this operation: open reduction and internal fixation of the distal phalangeal fracture of the right middle finger, non-excisional debridement of the subcutaneous tissue of the right middle finger, and a separate repair of the laceration of the right index finger. In ICD-10-PCS, the indexed entry for “Reduction, fracture” refers the coder to “Reposition.”  Since the intent of the procedure is to reposition the bone in the correct anatomical location, the root operation “Reposition” is assigned. ICD-10-PCS root operation guidelines for fracture treatment (B3.15) also indicate that reduction of a fracture is coded to the root operation Reposition. Table column selections representing the right finger phalanx, and open approach, and the use of an internal fixation device complete the code.


Similarly, the indexed entry for “Debridement, Non-excisional” refers the coder to the “Extraction” root operation. The body part value of “right hand” is assigned because there is no specific value for the finger. The separate repair of the index finger laceration is coded to the root operation “Repair,” and the Subcutaneous Tissue & Fascia” value is selected because the documentation states that the laceration was just distal to the insertion of the extensor tendon, indicating that the level was subcutaneous.




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