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Can 29999 be used for the capsular repair or would that be integral to repair of the CAM lesion?
Any assistance would be greatly appreciated. 
HPI:
*
Patient is a 62 year old male here after cutting off part of thumb.
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Left thumb amputation
– was cutting fire wood this morning with large axe
– leg bumped the handle and it chopped his left thumb off
– finished feeding the animals
– found thumb in snow, put it in bag with ice
– lives an hour out of town in Imnaha
– put some towels on it
– can still feel everything and move thumb around
– does sculpt, make handmade saddles
– right handed
*
Review of Systems
Constitutional: Negative for chills and fever.
Neurological: Negative for dizziness and tingling.
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Patient Active Problem List
Diagnosis
Ankylosing spondylitis of multiple sites in spine (HCC-CMS)
*
Current Outpatient Prescriptions
Medication Sig Dispense Refill
cephalexin (KEFLEX) 500 mg capsule Take 1 Cap by mouth 4 (four) times daily for 5 days 20 Cap 0
oxyCODONE-acetaminophen (PERCOCET) 5-325 mg per tablet Take 1 Tab by mouth every 8 (eight) hours as needed for pain 15 Tab 0
prednisoLONE acetate (PRED FORTE) 1 % ophthalmic suspension Place 1 Drop into the right eye 4 (four) times daily 10 mL 2
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Current Facility-Administered Medications
Medication Dose Route Frequency Provider Last Rate Last Dose
cefTRIAXone 1 g injection 1 g intramuscular Once Katie Putnam, MD
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Objective
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Vitals
Vitals:
* 02/19/19 0820
Pulse: 76
SpO2: 95%
Weight: 202 lb (91.6 kg)
Height: 6′ (1.829 m)
Last 3 Vitals
Office Visit from 2/19/2019
Temp 97.7 °F (36.5 °C) 98 °F (36.7 °C)
Pulse 76 75 56
BP 147/76
Resp 16 14
Weight 202 lb (91.6 kg) 196 lb (88.9 kg) 189 lb (85.7 kg)
*
Estimated body mass index is 27.4 kg/m² as calculated from the following:
Height as of this encounter: 6′ (1.829 m).
Weight as of this encounter: 202 lb (91.6 kg).
Facility age limit for growth percentiles is 20 years.
*
Physical Exam
Constitutional: He is oriented to person, place, and time. He appears well-developed and well-nourished. No distress.
Talking, making jokes.
HENT:
Head: Normocephalic and atraumatic.
Eyes: Conjunctivae and EOM are normal.
Neck: Neck supple.
Cardiovascular: Intact distal pulses.
Pulmonary/Chest: Effort normal.
Musculoskeletal: Normal range of motion.
L thumb: Traumatic amputation distal of IP joint. Extensor and flexor mechanisms in tact. Approximately 10% of the base of the thumb nail present. There is a small, arterial bleed near the palmar aspect of the thumb. Bone present underneath macerated tissue, some oozing from bone. Sensation appears to be in tact.
Neurological: He is alert and oriented to person, place, and time.
Skin: Skin is warm and dry.
Psychiatric: He has a normal mood and affect. His behavior is normal. Judgment and thought content normal.
Procedure: amputation repair / partial closure:
Anesthesia with 6 mL of 1% Lidocaine without Epinephrine used for digital block of L thumb. Wound cleansed, upon examination the wound probed to bone. 6-0 vicryl was used to place a single figure-of-eight suture at the site of a small arterial bleed, good hemostasis was achieved. There was continued oozing from the bone, so 4-0 vicryl and 3-0 ethilon were used to gently reapproximate the overlying skin; good hemostasis was achieved. Antibiotic ointment, xeroform dressing and gauze was used and the wound was wrapped with overlying coban. Wound care instructions provided. Single ceftriaxone shot was administered. Observe for any signs of infection or other problems. Return for wound examination in 1 day. Return for suture removal in 7 days.
Assessment and Plan: Patient is a 62 year old male here for finger amputation.
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1. Traumatic amputation of left thumb, initial encounter
2. Contact with workbench tool, initial encounter
3. Need for diphtheria-tetanus-pertussis (Tdap) vaccine
Traumatic amputation of the left thumb due to axe injury. Flexor and extensor function in tact. Wound cleansed and repair with gentle reapproximation of tissue as above. Discussed with orthopedic team in ***who stated that replant was a possible option but may be unsuccessful given time of injury. Patient declined to go to *** for evaluation. Good hemostasis was achieved with the repair, wound dressed with plan for check-up tomorrow. Recommending that patient be seen by orthopedic team in *** this week or next week; patient reluctant given concerns about transportation in winter weather. Will emphasize this recommendation again tomorrow. CTX and TDAP given today. Small rx for oxycodone-acetaminophen given as patient unable to take NSAIDs.
– IMMUNIZATION ADMIN
– TDAP (7 + YEARS)
– INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG
– cephalexin (KEFLEX) 500 mg capsule; Take 1 Cap by mouth 4 (four) times daily for 5 days Dispense: 20 Cap; Refill: 0
– cefTRIAXone 1 g injection; Inject 1 g into the muscle once
What code should we be billing the Hysterectomy? C-section was done by another Dr. (not in our practice). Our Dr. simply is doing the hysterectomy, bladder sling, etc. 58150 ? But the patient was cut open already….maybe with a Mod 52 (reduced services)? Or Mod 62 (two surgeons)?
Any help would be much appreciated!
Summary of encounter: Patient had increasing angina. Progressive symptoms were discussed with the interventional cardiologist. It was decided that the patient should continue to maximize medical therapy. "We will have the patient return for stress testing if his symptoms do not improve." The patent called the CNP on 4/12/18 and noted no improvement in his symptoms. A myoview stress test was ordered for the next day. Can the plan for the myoview stress test be counted in the MDM for 4/4/18, or because the "final decision" for it was not made until 8 days after the face-to-face encounter, does it not count toward the level on 4/14/18?
Pam Schmitt, RHIA, CCS, CCS-P, CPC
As a Federally Qualified Health Center the mass majority of our patients are Medicare and/or Medicaid; and need supporting documentation from CMS.
Any help on this question is greatly appreciated.
Charlene
[email protected]
I don’t normally code for fractures, but I was hoping someone here could help. I have a provider submitting code S42.302S, sequela from fracture of the shaft of the left humerus. I know she needs two codes when billing for sequela, and the current problem is that the elderly patient is now experiencing a decreased range of motion in her left arm, as a result of the earlier fracture. How would you code for this?
thanks!
INPATIENT: Chronic hypertension. Fetal anomaly suspected. Fetal anatomy survey.
History
========
Past surgical history No previous surgeries performed.
OB History Gravida: 2. Para: 0.
A1.
Miscarriages: 1.
Thank you!!
POSTOPERATIVE DIAGNOSIS(ES): Dehiscences of the left knee wound.
OPERATION: Irrigation and debridement the soft tissue repair and closure of
the left knee wound.
INDICATIONS FOR SURGERY: This 83-year-old female was about 3 weeks after
revision of her total knee replacement. Patient developed some dehiscence in
the wound with a small amount of drainage, with no redness around the
incision.
DESCRIPTION OF PROCEDURE: With the patient on the OR table, under general
anesthesia, the dressing was removed. The wound was assessed. Several
cultures were taken, deep and superficial, and were submitted for aerobic and
anaerobic Gram stain examination. Following that, intravenous antibiotic was
administered and the leg was prepped and draped in a sterile fashion. Time-
out was called. The patient was identified and the surgical site was
confirmed. Risk factors and allergies were discussed. As I stated earlier,
intravenous antibiotic was administered and we then extended the wound a
little bit proximally to get into some healthy tissues by blunt dissection.
The skin was separated from subcutaneous tissues and I realized that the
defect was actually in the capsule repair medially. We mobilized some of the
capsule medially and since we did have reasonable tissue laterally, I thought
we will be able to repair it snugly. We then used a pressure irrigation
system and we used a little bit over a liter of the antibiotic solution with
the pressure irrigation system to irrigate the wound. Once irrigation was
completed, we used the #2 FiberWire suture to repair the capsule, which
actually came together very nicely. We then irrigated the wound with the
pressure irrigation system one more time and used subcutaneous 0 Vicryl
sutures to approximate the skin. Following that, we used the 0 nylon type
suture to close the skin with multiple interrupted sutures in a vertical
mattress fashion. A very good repair was obtained. There was no drainage
coming from the wound. Aquacel dressing was applied. The patient was then
awakened and extubated in the operating room and moved to the recovery room
in satisfactory condition, tolerating the procedure well.