Ryan Posted Wed 24th of June, 2020 07:39:56 AM
WHAT CODE CAN I USE FOR THE IM ROD FIXATION OF THE FIBULAR? HE DOES CORRECT AND PLACE THE NAIL THROUGH THE SHAFT OF THE FIBULAR: Patient was prepped and consented in usual standard fashion. Patient was brought to the operating placed supine on the operating table. Left upper extremity regional block was given by the anesthesiology team. Anesthesia given by the anesthesiology team. The left lower extremity was prepped and draped in usual standard fashion. Proximal thigh tourniquet was applied inflated to 300 mmHg after exsanguination. We identified the fracture was a bimalleolar fracture with Weber C pattern. We made a 2 inch incision directly over the fracture site on the fibula skin was sharply incised subcutaneous tissue bluntly dissected. Promius muscles were carefully retracted and the fracture site was identified hematoma evacuated. Open reduction of the fibula fracture was performed and held with bone clamp. Next under fluoroscopic control we passed a guidewire from the tip of the fibula up the shaft using Arthrex fibular nail jig. Next once it was appropriately positioned we drilled this to appropriate size to accommodate a 130 mm nail. This was carefully passed from distal through the isthmus of the fibular shaft. Reduction was held by my assistant with bone clamps. Good alignment was noted post nail passage. Next using the jig we placed 2 screws through the nail at the distal end. Prior to this the proximal talons were deployed to gain rotational controlled proximally. Next we placed syndesmotic tight rope fixation through 1 of the holes of the nail. Appropriate drills was used to pass the 4 cortices of fibula and tibia left. Next while the guidewire was placed across the syndesmotic hole we percutaneously fixed the medial malleolus with 2 short threaded cannulated screws. Good fixation of the screws was noted. Next we passed the tight rope from lateral to medial deployed it medially and tightened it laterally. Good stable fixation was noted with reduction of the medial joint space of the ankle. Wounds were thoroughly irrigated with normal saline. Wounds were closed in layered fashion. Sterile dressings with a posterior splint was applied. Tourniquet deflated all toes pinked up nicely.
SuperCoder Answered Thu 25th of June, 2020 02:39:04 AM
Ryan Posted Thu 25th of June, 2020 09:04:30 AM
i am trying to see what cpt code can be used for the IM rod fixation of the fibular. I am assuming an unlisted code will have to be used but what cpt code will it compare?
SuperCoder Answered Fri 26th of June, 2020 08:14:40 AM
Yes, the unlisted code will be appropriate to bill as there is no such specific code defined for IM rod fixation of fibula. On one hand, for tibia and fibula shaft fracture treatment by intramedullary implant there is only procedure code available i.e. 27759. So, this can be given as comparative code. In this code, the provider treats a tibial shaft fracture with by placing a nail or rod in the intramedullary canal. He may or may apply interlocking screws and or cerclage. This procedure may or may not involve fibular fracture. He does not treat a fibular fracture separately, if present. He performs the procedure to keep the fracture in alignment and prevent displacement while the fracture heals and to relieve pain. So, the nailing portion of the procedure can be compared with the unlisted code.
Also, when reporting a procedure with an unlisted code, submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Included code can be compared for your service to justify the claim you are billing. Also include the operative notes or other relevant documentation to strengthen the claim and to avoid a possible denial. Your payers will consider claims with unlisted procedure codes on a case by case basis, and they will determine payment based on the documentation you provide.
Hope this helps!