This patient has a history of ADD. He presents the emergency department with his mother

This patient has a history of ADD. He presents the emergency department with his mother complaining of foreign body in his left index finger. He states that he was shooting targets with his BB gun at home in his yard as this is his hobby and the BB ricocheted and hit him in the tip of his left index finger. The shot was fired by the patient and ricocheted off a brick approximately 30 feet away. He reports the BB is in the tip of his finger and is very painful. This happened approximately 2 hours prior to arrival. He has some paresthesias in his fingertips but no weakness. He is right handed. No treatment prior to arrival. Vaccines up-to-date per mother No other injury. History obtained from: Patient, mother Location: Left index finger Duration: 2 hours Severity: Severe Timing: Sudden onset Associated Symptoms: injury, paresthesias Denies Symptoms: no focal weakness Past Medical History: Asthma, ADD Review of Systems: Musculoskeletal: Injury to left index finger Skin: Abrasion/laceration Neurologic: Paresthesias, no focal weakness Vitals: Temperature: 98.6°F Pulse: 87 Respirations: 17 Blood Pressure: 120/60 SpO2: 99% Physical Examination: Examination of the left upper extremity reveals a puncture wound in the second left digit over the palmar aspect of the distal phalanx with some dried blood, moderately tender. He reports diminished sensation to light touch in this fingertip but otherwise sensation is intact strength intact, normal tendon function, no deformity with full range of motion. 2+ pulses with normal perfusion. General: Alert & oriented x 3. Comfortable. Head: Atraumatic-normocephalic Eyes: Sclera normal Respiratory/Chest: No respiratory distress Musculoskeletal Extremity: Peripheral pulses present Skin: Warm and dry Psychiatric: Oriented x3 ED Clinical Course: Patient was evaluated promptly on arrival. He is afebrile with stable vital signs at presentation. He was sent for an x-ray of his finger which shows foreign body as expected but no evidence of fracture. Results were discussed with patient and mother. Verbal consent given for foreign body removal. Anesthesia was obtained by digital block, incision was lengthened slightly and after some blunt probing I was able to localize the foreign body and remove after several attempts successfully. Wound was irrigated with sterile water. Bleeding controlled, 1 suture placed for hemostasis. Tendon function was again rechecked and remains intact after procedure. Patient was given Motrin for pain and Keflex for prophylaxis. Dressing with bacitracin applied. He was provided an ice pack and advised to ice and elevate to decrease pain and swelling. Home care and follow-up instructions given along with return precautions. Patient and mother report agreement and understanding. All questions answered. He remained stable throughout his stay in the emergency department and was discharged to home in stable condition. Procedure Details: Indication: Foreign body in left index fingertip Nature and Location of Foreign Body: BB in the distal left index fingertip Incision: Superficial, Simple Foreign Body: Removed Complications: None Tolerance: Good Additional Details: Anesthesia obtained with 1% lidocaine via digital block. Wound was prepped and dressed in a sterile fashion. The puncture wound was cleansed and elongated very minimally with an 11 blade. Wound was probed and localized with pickups, deformity body was very mobile but ultimately, I was able to remove foreign body with pickups. Disposition: Treated and released Additional procedures: Radiology exam, left index finger. Condition at Discharge: Stable Prescriptions: Cephelexin 500mg oral capsule, 1 cap orally every 8 hours x 7 days (quantity 21), no refills Follow-up Instructions: Follow up with PCP or specialist within 7-10 days for suture removal. Return to the emergency department for persistent, worsening, or new symptoms including signs of wound infection or any other concerns. Wash wound daily with soap and water. Apply a small amount of antibiotic ointment and dressing and take all antibiotics to prevent infection. Ice and elevate several times a day to decrease pain and swelling. Final Assessment: Puncture wound of left index finger with foreign body. Electronically Signed By: Charles Baker, MD Imaging ReportExam: X-Ray of Left Index Finger Technique: Left index finger 3 views Indication: Foreign body Finding: There is a foreign body in the soft tissues on the palmar surface of the distal left index finger. No evidence of fractures. Impression: Radiopaque foreign body is visualized in the soft tissues on the palmar surface of the distal left index finger. No fractures. what are the four codes?

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