Orthopedic Coding Alert

Question: The patient had a comminuted surgical neck fracture with displaced humeral shaft reduced six months ago, treated nonoperatively. He now has an open reduction and internal fixation with intramedullary rodding with a Polaris nail, proximal humerus, for diagnosis of a delayed union. How should I code this? Maryland Subscriber Answer: A delayed union occurs when callus forms more slowly than expected. This differs from a nonunion, when healing fails to progress altogether.

Code a delayed union using the ICD-9 code for the fracture since a fracture is still present. In this case, 812.21 (Fracture of humerus, shaft, closed) and 812.00 (Fracture of humerus, upper end, unspecified part, closed) should be reported.

For the surgical procedure, report humeral fracture treatment code 24516.

If your physician feels that the work associated with the procedure was greater than the norm due to extensive comminution of the fracture and the delayed healing status, you can append modifier -22 (Unusual procedural services) and request a higher amount be reimbursed. This will require submission of strong supporting documentation with the claim. You Be the Coder and Reader Questions were answered by Heidi Stout, CPC, CCS-P, coding and reimbursement specialist at University Orthopaedic Associates in New Brunswick, N.J.; Stanley M. Szelazek, CPC, CCP, certified orthopaedic proficient compliance officer at Lighthouse Orthopedic Associates in Lighthouse Point, Fla.; Christie Beach, CPC, of Comprehensive Orthopedics in Kenosha, Wis.; and Billy Jo McCrary, CPC, CCS-P, practice manager for Wellington Orthopaedic & Sports Medicine in Cincinnati.