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Geri Posted Mon 22nd of October, 2012 13:31:54 PM

Is application of an external fixator - 2 pins in the tibia and 2 pins in the calcaneus singleplane or multiplaine external fixation? 20690 or 20692

SuperCoder Answered Mon 22nd of October, 2012 22:32:58 PM

Coders may find deciding between uniplanar and multiplanar codes to be tricky,But if you look for these clues in your op reports, you-ll be one step closer to choosing the proper code.

Clue 1: If You Spot -Ilizarov- or Hybrid, You-re Home-Free

Code 20692's descriptor includes Ilizarov and Monticelli types as examples of multiplane external fixation systems, so if you see either of these terms, you should home in on 20692.

Ilizarov in focus: An Ilizarov system "looks like a series of bicycle wheels placed around the extremity (most often the leg), connected by thin wires,".

"The Ilizarov device is still available, but most trauma companies make a variant of it. You can look for the term Ilizarov, or ring fixation, but it may go by another name,".

Hybrid tip: A hybrid is multiplanar because it combines a ring fixator and uniplanar fixator.

Other terms, such as "spanning," which means "goes across a joint," don't help you determine whether to use the uniplane or multiplane code.

Good news: There are a few more clues you can look for to keep you on the right track.

Clue 2: Get a Fix on Fracture Location

Surgeons use uniplane fixators almost exclusively for shaft fractures, especially midshaft tibia fractures, such as 823.20 (Fracture of tibia and fibula; shaft, closed; tibia alone) or 823.30 (- shaft, open; tibia alone).

Surgeons typically fix most intra-articular fractures in the leg with ring fixation. These fractures include tibial plateau (knee) (such as 823.00, Fracture of tibia and fibula; upper end, closed; tibia alone), tibial plafond (824.8, Fracture of ankle; unspecified, closed) or pilon (ankle). The appropriate diagnosis may be 823.80 (Fracture of tibia and fibula; unspecified part, closed; tibia alone), 823.82 (- fibula with tibia), 823.90 (- unspecified part, open; tibia alone) or 823.92 (- fibula with tibia), based on the surgeon's documentation.

Clue 3: Pin Size Points to Proper Code

The pin the surgeon uses may point you in the right direction to choose between 20690 and 20692.

Uniplane fixators use thicker, more solid pins for fixation than multiplane fixators. Ring fixator pins are much narrower, and the surgeon places them under tension, he says. "So if you see the terms -thin wire- or -thin pin,- or see a description of -tensioning- the pins, this is almost certainly a ring, or multiplane, fixator,".

Don't miss: If you see the term "olive wire," you are definitely coding a ring fixator. The term refers to some of the thin wires that have a protruding end. Surgeons never use these wires with uniplane fixators.

Clue 4: Where Does the Pin End?

"Uniplane fixators usually have the pin drilled into the bone, but not out of the opposite side of the extremity.

Surgeons drill ring fixator pins through the bone and out of the extremity's other side.

Clue 5: Imagine Femur Ring Fixator Discomfort

When the femur or humerus requires external fixation, the surgeon is much more likely to choose uniplane fixation.

"Distal extremities are much more amenable to ring fixators. The tibia and forearm accept a ring fixator more readily,".

The pelvis is an exception, though,And coders may have particular difficulty with pelvic cases,

Example: Suppose the patient's fixation device allows the patient to lie flat -- which means it has no true rings -- but the bars do go up and cross over the pelvis.

Solution: The pelvis falls outside of the rule that ring and multiplanar fixation are synonymous. "The pelvis rarely gets true ring fixation, but almost any external fixation system placed on the pelvis must, by definition, be multi-planar.

Remember, uniplanar means occurring in one plane -- the device is essentially straight and flat. Multiplanar means occurring in more than one plane, so if the device has bars going up (one plane) and across (another plane), the device is multiplanar.

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