Question

Preop Diagnosis: Foreign body on the left little finger at the metacarpal phalangeal joint (broken piece of glass)

Postop Diagnosis: Same

Operation: Exploration of the MP joint of the left little finger with excision and removal of foreign body (broken pieces of glass)

Indication of Surgery: On June 9, the patient was involved in a motor vehicle accident. She was a passenger and somehow their automobile hit a pedestrian and the

pedestrian’s body flew up and hit the windshield, breaking the windshield. She tried to brace herself with her left hand and sustained a laceration on the dorsum of the

metacarpal phalangeal joint of the left little finger. At that time she did not think anything of it. She did not even see a physician. The wound subsequently healed, but she

stated (started) noticing some pain in that region. On August 19, she accidentally hit the metacarpal phalangeal joint of the left little finger against something and since then she

has been complaining of severe pain and numbness. She had an x-ray of her left hand which revealed a foreign body in the metacarpal phalangeal joint of the left little finger.

The patient was referred to me. I explained to the patient I need to open up the wound, explore the area, and remove the foreign body. The possible risks, benefits, and

possible complication of the procedure were explained.

Technique: The patient was placed on the OR bed, assuming the supine position. Blood pressure monitoring and pulse oximetry monitoring were in progress. The left

hand and forearm were prepped and draped. Initially, I tried to palpate the metacarpal phalangeal joint until I found the areas that is the most tender. This area is located at

the dorsum of the MP joint of the left little finger proximal to the previously healed scar. This area was then marked out and infiltrated with 1 percent Carbocaine solution. An

oblique incision was then made over the area parallel to the old scar. Incision was deepened and bleeders were fulgurated with high temperature. By careful sharp and

blunt dissection, the foreign body was searched for. For a while, I could not find the foreign body. Therefore, the incision was extended distally towards the previous area of

the laceration. After searching for some time, it was found that the dorsal digital nerve in this area was intact. It was retracted out of harm’s way and the area near the

extensor tendon toward the foot of the extensor tendon. The foreign body was wedged underneath the foot of the tendon in the joint space. It was a piece of broken glass and

measures about 2 x 3 x 1 mm. It was completely extracted and removed. The wound was irrigated with a large amount of saline solution. Wound closure was accomplished

with 5-0 nylon interrupted mattress sutures. Compression dressing was applied. The patient withstood the procedure well.

What is the final ICD-10-PCS code assigned?

One code only!

Additional information: The intention is to remove foreign body which is evidenced by information in preoperative diagnosis line and under “Indication of surgery”. The time to

find the foreign body is not separately coded. The wound closure at end of procedure is not separately coded. The surgical approach is noted by documentation as “An oblique

incision was then made...By careful sharp and blunt dissection...dorsal digital nerve was retracted...” all of this points to more than percutaneous. The physician used a

scalpel to make the cut or the incision. After finding it the foreign body, though small was removed.

Answer 1

0 Medical and Surgicals

                   R Joint

                     C Extripation

                        V Metacarpophangeal left  

                           0 Open appoach

                               Z No device

                                  Z No equalifier

                               

Approach	Device	Qualifier
0 - Open	Z - No device	Z - No qualifier
3 - Percutaneous
4 - Percutaneous Endoscopic

The is cd-10 procedure code is 0RCV[034]ZZ