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#1
08-08-2012, 02:08 PM
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Need help PLEASE 27829
Can someone please tell me whether this is the correct dx 845.03 with cpt code 27829? The cross coder and coding companion state I need to use a dislocation diagnosis. But the nurse is insisting I use the sprain and strain dx. Can someone please guide me!! I’m attaching the op report below.
She presented to our office where she was found to have a fibular fracture which appeared to be segmental with widening of medial clear space, widening of syndesmotic space, and small posterior malleolus fracture. An incision of approximately 5cm in lenth was made along the fibular fracture. Dissection was carried down through subcutaneous tissues where the fracture was found to be segmental and displaced. The incision was extended through approximately a length of 10cm. Care was taken to avoid injury to superficial peroneal nerve which lay with in the field. The fracture was identified and reduced and held temporarily with several claims. Three lag screws were placed from anterior rule out posterior across the fracture fragment which held them temporarily. An 8-hole locking plate was then fixed over the lateral aspect of the lateral malleolus. This provided excellent rotation as well as length stability of the fibula. Syndesmosis was next reduced and medial clear space was nicely closed down with reduction of syndesmosis. Syndesmosis was held reduced with ankle in maximum dorsiflexion and tightrope was place. We are billing 27784 dx 170.7 27829 dx 845.03 Does anyone else use the crossover manual? 
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#3
08-10-2012, 07:07 AM
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Why have you coded the 170.7? That is for a malignant neoplasm of the long bone which is not documented for this patient, neither is a sprain documented, I see a fibular fx and a syndesmosis, you should use the ICD-9 code book for your diagnosis codes and not a cross coder. clearly the cross coder is not providing the diagnosis codes for what the provider documented for this patient. Hopefully this has not been billed out with these diagnosis codes as the patient's payer will attach these diagnosis codes to this patient's risk profile.
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Debra A. Mitchell, MSPH, CPC-H 
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