Metacarpal fracture

Orthopedist tended to a patient in the emergency department for a gunshot wound and diagnosed a metacarpal fracture. He irrigated the site and eliminated a foreign body. That time you can report fracture care along with irrigation 20103. Do not code a closed fracture treatment without more information.

Question: Our orthopedist tended to a patient in the emergency department for a gunshot wound and diagnosed a metacarpal fracture. He irrigated the site and eliminated a foreign body. Can we also go for a fracture code even though he did not manipulate the fracture?

Answer: If the documentation lists the fracture as a diagnosis (815.1x, Fracture of metacarpal bone[s]), you can report fracture care along with irrigation 20103 (Exploration of penetrating wound [separate procedure]; extremity).

If the notes document debridement, you might be able to report 11012 (Debridement including removal of foreign material associated with open fracture[s] and/or dislocation[s]; skin, subcutaneous tissue, muscle fascia, muscle, and bone) in place of 20103.

Keep a watch: When dealing with a contaminated wound, definitive fracture fixation would most probably be delayed until the immediate threat of infection passes. Owing to this, do not automatically submit a closed fracture treatment code unless you have more information to guide your choices. Go for a code for closed treatment without manipulation like 26600 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) unless the fracture called for additional treatment while performing the open debridement.