Orthopedic Coding Alert

Watch out: Even documented procedures aren't always billable Proper coding often depends on knowing what to report. But knowing what not to report can be just as important.
 
For instance, standard of care and bundling guidelines (whether imposed by CPT, CMS or third-party payers) often limit which procedures you can claim separately. To be certain that you are capturing all the reimbursement your physician deserves without overcoding, first list all the identifiable procedures in the documentation and then go back and look for bundles. Check Out the Op Report To test your skills, consider how you would code this sample surgical note. Then read on to see how you fare: Preoperative diagnosis: Left closed intertrochanteric femur fracture. Postoperative diagnosis: Left closed intertrochanteric femur fracture. Procedure: Open reduction left intertrochanteric femur fracture with dynamic hip screw and four-hole plate. Procedure justification: 25-year-old male involved in vehicle collision in May 2005. The patient sustained a fracture and dislocation of C7 and T1 with a complete spinal cord injury. The patient at that time also sustained a closed intertrochanteric femur fracture. Initial plan was to manage patient nonoperatively, but follow-up showed nonunion of left intertrochanteric femur fracture. Therefore, scheduled open reduction, internal fixation of injury in July 2005. Procedure: Fluoroscopy was brought into the room, and under direct visualization, we properly positioned patient so that the fracture was in the best alignment - Using the fluoroscopy, the level of the greater trochanter was verified - a longitudinal skin incision was made - the subcutaneous tissue and muscle were also sharply dissected down to the level of the proximal femur - care was taken to remove all the excess callus that had formed - this caused significant bleeding [that was] monitored by the operative surgeon and the anesthesiologist.
 
- Care was taken to achieve the proper alignment - Once alignment had been achieved, the appropriate-size plate was selected - large clamps [were used] to maintain the reduction and hold the plate. [The plate was secured] under direct fluoroscopy - it was found that the patient would benefit from a 90-mm screw to be placed in the proximal screw hole - Again fluoroscopy [was used] - the remainder of the distal four holes were appropriately filled.
 
The wound was copiously irrigated with large amounts of saline - closure [was achieved] - and the patient was removed from the fracture table.

How would you code this note?
 A. 27244, 76000-26, 20650-59
 B. 27244-22, 76000
 C. 27248, 76000-26
 D. 27244. Consider All Possibilities  If you scan the op report, you can identify the following procedures and services:

 - Use of fluoroscopy
 - Incision and approach
 - Site preparation
 - Control of bleeding
 - Fracture reduction
 - Placement and securing of plate
 - Closure. The primary procedure in this case is the open reduction of the left intertrochanteric femur fracture with [...]