Pinpoint the Correct Codes for Pediatric Orthopedic Cases
Find out how to code limb length discrepancies. Pediatric orthopedic surgeons represent a small segment of the orthopedic surgery community, with only about 10 percent of orthopedic residents choosing pediatric fellowships annually. Because this orthopedic subspeciality population is so small, many coders have little or no exposure to coding the services of pediatric orthopedic surgeons. Read on to learn about pediatric orthopedic conditions and how to code them. What Conditions Do Pediatric Orthopedic Surgeons Treat? Pediatric orthopedic surgeons treat a wide variety of musculoskeletal issues ranging from acute injuries to congenital (present at birth) deformities. Because children’s bones are still developing, these specialists focus on managing conditions that affect growth plates and long-term skeletal health. Commonly treated conditions, which are discussed later, include: Other conditions are as follows: Let’s take a look at how to code common conditions that pediatric orthopedic surgeons treat. Fix Your Fracture Treatment Coding Knowledge Fracture repair is the most frequent surgical procedure performed by pediatric orthopedic surgeons. Children are particularly prone to growth plate fractures, often referred to as Salter-Harris fractures. A Salter-Harris II fracture of the left distal radius (S59.222A [Salter-Harris Type II physeal fracture of lower end of radius, left arm, initial encounter for closed fracture]) may be treated with or without surgery depending on the stability of the fracture. A stable fracture may be treated with casting, while a displaced fracture may require one of the following treatments: A Tillaux ankle fracture, also known as a Salter-Harris III fracture, is unique to adolescents and involves the articular surface of the tibia. Look to codes 27824-27825 (Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia …) for closed treatments and 27826-27828 (Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed …) for open treatments of these fractures. Recognize How to Code Sports and Overuse Injuries Pediatric orthopedic surgeons treat several types of sports injuries, such as anterior cruciate ligament (ACL) tears, meniscus injuries, and shoulder dislocations. Surgeons will often repair meniscal tears in younger patients. A peripheral tear of the right lateral meniscus may be repaired arthroscopically. For that scenario, assign S83.261A (Peripheral tear of lateral meniscus, current injury, right knee, initial encounter) to report the diagnosis and use 29882 (Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)) appended with modifier RT (Right side) to report the arthroscopic repair. Orthopedic surgeons also treat a number of overuse injuries in their pediatric patients. Conditions like Osgood-Schlatter disease or juvenile osteochondrosis of the tibial tubercle and calcaneal apophysitis are frequent in active adolescents, but the conditions rarely require surgical intervention. Code Spinal Conditions and Treatments Two conditions that a pediatric orthopedic surgeon might deal with are scoliosis and kyphosis. Abnormal curvatures of the spine like these are a primary reason for long-term monitoring. Definition: Scoliosis is a sideways curve of the spine, whereas kyphosis is a forward curve of the spine. Treatment for these conditions may include bracing and surgery. When surgical intervention is required, the treatment depends on the type of condition. Flexible curves require fusion, fusion with instrumentation, or vertebral tethering, which are reported with the following codes: Rigid curves or congenital vertebral anomalies can require osteotomy, fusion, or fusion with instrumentation, which are reported with the following codes: Spondylolysis/spondylolisthesis: Stress fractures in the lower back can cause vertebrae to slip. These conditions are most often treated with rest, activity modification, physical therapy, medications, and sometimes bracing. A severe vertebral slip may require surgery. Limb length discrepancy: Congenital lower limb length discrepancies are reported with the following code categories: Report acquired lower limb length discrepancies with a code assigned to the shorter limb. Assign M21.762 (Unequal limb length (acquired), left tibia) for a patient with an acquired leg length discrepancy where the left tibia is shorter than the right. Patients may require complex surgical procedures to correct limb length discrepancies. Pediatric leg shortening and lengthening surgeries correct significant leg length discrepancies by gradually separating a surgically cut bone, allowing the body to form new bone in the gap using external frames or internal rods over several months. Surgical correction techniques include: The provider may use external fixation (20690-20697) or internal fixation with a rod to stabilize the limb during healing. A newer internal fixation technique uses motorized rods, referred to as growing rods, inserted inside the bone. The rods are periodically adjusted magnetically or via remote control as the limb lengthens. 2026 CPT® updates: The 2026 CPT® code set includes two new codes representing procedures performed to treat limb length discrepancies using a technique called distraction osteogenesis: Heidi Stout, CPC, COSC, President, Coder on Call, Inc.
