Fish-Mouth incision in forearm
by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
The patient had a below-the-elbow amputation of the right forearm. The surgeon described using a fish-mouth type of flap closure. My students in class recently questioned whether this flap closure should be coded separately.
The fish-mouth incision is typical when the surgeon is performing an amputation, or the PCS root operation of Detachment. The fish-mouth is made distal to the proposed point of bone detachment.
The flaps created by the incision are not typical flaps, such as those used in the root operation of Transfer. These flaps are retracted and the internal structures are detached at the appropriate level and removed. The flaps are not rearranged or moved in any way. After the detachment is complete, they are closed to form the stump for the patient.
Closure of flaps to form stump
In our question above, we code only the detachment of the right forearm. The Detachment procedure is coded only in two body systems: Anatomical Regions, Upper Extremities or Anatomical Regions, Lower Extremities.
If the surgery was performed as shown in these images, the body part is D, Lower arm and the qualifier assigned would be 2, Mid for a complete code of 0X6D0Z2, Detachment of the right lower arm at the midpoint. No transfer of a body part took place and therefore, no transfer is coded.
