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Code This!

Scenario Week of May 18, 2012:
View Current Scenario

Tech I: N VanHorn
Tech II: D. Hall

Preoperative Diagnosis: Foreign body, right thigh

Postoperative Diagnosis: Same

Indications:
A 9-year-old male was stabbed in the right thigh with a stick while playing. The area of the injury is sore and the patient’s mother thinks there is still a foreign body in the wound. The mother tried to get out the sliver of wood but according to the mother it was too painful. Plan to remove FB thigh.

Informed Consent:
The risks and benefits of the procedure were explained to the parent. The parent elected to proceed with the procedure.

Approach and Surgical Procedure:
The patient was brought to our minor surgery room, and his thigh was prepped and draped in the usual sterile fashion. The area was injected with a local anesthetic. After an appropriate time I irrigated the wound with a normal saline flush.

Using a small retractor, the edges of the wound were opened. The splinter was clearly visible and appeared to barely extend into the muscle. I grasped the foreign body and removed it simply. The wound was irrigated again and packed with a short piece of ¼ inch plain gauze, and a sterile dressing was applied to the wound.

The patient tolerated the procedure well. He will return in 2 days for follow-up.

Code This!


Coding Answers

CPT Procedure Code:
20520 Removal of foreign body in muscle or tendon sheath; simple

Rationale:
For this procedure, removal foreign body of the right thigh, refer to the CPT index under the main term “removal” and subterms “foreign body” and “muscle” (since the foreign body extended to the muscle). There you are referred to codes 20520–20525. In the musculoskeletal section, code 20520 describes removal of foreign body in muscle or tendon sheath; simple, and 20525 describes deep or complicated removal. The documentation stated that the foreign body barely extended into the muscle and was simply removed; therefore, the appropriate code choice would be 20520 for this procedure.

ICD-9-CM Diagnosis Codes:
890.1 Open wound of hip and thigh, complicated E920.9 Accident caused by unspecified cutting and piercing instrument or object

Rationale:
Under the main term “foreign body” in the alphabetic index, there is an instructional note that directs the coder see the main term “Wound, open” or the specific type of injury. For the foreign body of the right thigh, the correct codes are found in the ICD-9-CM alphabetic index under the main term “wound, open” and the subterm “thigh” which references code 890.1.

Code 890.1 in the ICD-9-CM tabular listing describes an open wound of the hip and thigh that is "complicated.” Because the wound of the thigh was found to contain a foreign body, it is considered a complicated wound. In this case, code 890.1 should be reported.

Next a code is assigned for the circumstance that caused the injury, which is described by E codes. For this code, look in the ICD-9-CM external causes alphabetic index, section 3, under the main term “Cut, cutting” and the subterm “by” then “splinters” which references code E920.8.

Turning to the tabular list to category E920 we find an instructional note stating that accidental injury by an edged, pointed, or sharp object is included in this category. Code E920.8 includes splinters and is the appropriate code for this injury.

 
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