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Old 04-07-2009, 03:14 PM
coderguy1939 coderguy1939 is offline
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Default Articular Fracture Proximal Phalanx

I keep struggling with this one, so I'm hoping someone has so definetive information on how to code this.

Doctor did a closed reduction of an articular fracture of the proximal phalanx and placed two percutaneous k-wires. I'm looking at 26742 but how do you get the k-wires? Are they billed as supplies? Would it be better to use an unlisted code? Help!!!
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Old 04-08-2009, 06:31 AM
KatieGal KatieGal is offline
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Look at code 26727 - as it states "percutaneous pinning" this would be the K-wires.

Per the Coders Desk Reference - " The physician treats a phalangeal shaft fracture of the proximal or middle phalanx, finger, or thumb with manipulation and secures it with a wire".

Kate, CPC, COSC
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Old 04-08-2009, 07:52 AM
Bella Cullen Bella Cullen is offline
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I agree with katiegal.
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Old 04-08-2009, 11:19 AM
coderguy1939 coderguy1939 is offline
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This is an articular fracture which would place it at the proximal phalanx joint, so I don't think shaft fracture would apply.
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Old 04-09-2009, 08:16 AM
Bella Cullen Bella Cullen is offline
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Maybe look at 26706 in CDR it says, the physician manipulates a metacarpophalangeal dislocation to restore anatomical position and secures the bone with a wire. The physician determines the dislocated position of the bone. The bone is relocated to correct anatomical position using external manipulation. The physician drills a wire into the metacarpophalangeal joint, through the fracture, and into the proximal bone. The drill entry point is dressed and the hand is splinted. And I got the definitions of dislocation fracture and articular fracture, and I think this one might work for you, by reading those. What do you think? I hope that helps. If not, then I guess it would be unlisted.

dislocation fracture
Type: Term

Definitions:
1. a fracture of a bone near an articulation with a concomitant dislocation of the adjacent joint.


articular fracture
Type: Term

Definitions:
1. a fracture involving the joint surface of a bone.
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Old 04-17-2009, 02:56 PM
coderguy1939 coderguy1939 is offline
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Thanks for all your input on this one. I'm going with an unlisted code.
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Old 04-20-2009, 01:02 PM
pmaho pmaho is offline
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If the fracture/dislocation is at the metacarpalphalangeal joint (MTP), PIP or DIP, then 26742.

Patrick
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