Victoria Posted Tue 05th of November, 2019 11:10:59 AM
We are having an issue getting a surgery paid. Our doctor feels that his dictation supports 27244, but the insurance company states it does not. We would like a second opinion on what code you would use. Here is the operative report: "On the day of the operation, I met the patient in the preoperative holding area, marked the correct surgical site, reviewed the risks and benefits of the operation and answered all their questions. He was taken to the operative suite, succumbed to general anesthesia and were placed supine on a Hanna table. All bony prominences were appropriately padded. They received perioperative antibiotics within 30 minutes of the incision which were Ancef. We performed a timeout, identified the correct patient, surgical site, procedure to be performed. Before prepping and draping the leg, I used the Hanna table to perform a manipulative reduction with traction, internal rotation and slight adduction. On the lateral radiograph, I manipulated the image and leg until the shaft and neck were aligned with an acceptable reduction. This was checked on the AP projection and manipulated until reduction was acceptable. We then prepped and draped in the usual sterile fashion and performed a time out as per protocol identifying the correct patient, surgical site, procedure to be performed we verified antibiotics had been give. I then placed a guidewire at the medial tip of the trochanter in the trochiformis location and this was centered on the AP and lateral projection past distal to the fracture. I did a limited reaming, using only one size (12mm) and pushing it in to the canal and only turning it on briefly in the narrowest part of the canal. I placed a 11mm nail and I measured the length of the device and found it to be a 42 cm nail. I then put the proximal reamer down past the level of the lesser trochanter being sure to preferentially ream away the medial bone and not drift laterally. I then placed the cephalomedullary nail and the guidewire from the nail was removed such that the wire up into the femoral head could be appropriately placed in the center-center position on the AP and lateral projections. This was measured and then a 110-mm screw was placed. I checked to make sure this did not distract the fracture. The screw was then compressed and locked in a dynamic position to allow for collapse. I then placed my distal interlocking bolt through the nail using perfect circle technique verifying as the appropriate length on the AP projection and that it was through the nail on the lateral projection. I took final AP and lateral radiographs at the hip and at the distal aspect of the nail and it showed that the screw into the femoral head was center-center, it was not too long into the hip joint, my reduction was acceptable, the distal interlocking bolt was through the nail and of the appropriate length. I checked the hip on multiple projections to ensure the screw was not within the hip joint and was in a safe position. I then copiously irrigated all incisions, closed the deep tissue with interrupted 0 Vicryl, subcutaneous tissue with interrupted 2-0 Vicryl and then staples for the skin. I placed a sterile dressing. Then patient was awakened from anesthesia in stable condition.
SuperCoder Answered Wed 06th of November, 2019 02:28:18 AM
As this question requires coding of the operative report, you need to post this in SuperCoding on Demand (SOD) portal (http://www.supercoder.com/coding-answers/coding-on-demand) for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail firstname.lastname@example.org for more information.
The charges for coding of this orthopedic operative report is $55. As you have already paid $25 for AAE, kindly make an additional payment of $30 for the coding of this operative report.