Orthopedic Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.

Question: How should I code the following? The patient had a comminuted surgical neck fracture with displaced humeral shaft reduced six months ago, treated nonoperatively. He now has an open reduction with internal fixation with intramedullary rodding with a Polaris nail, proximal humerus for diagnosis of a delayed union.

Hawaii Subscriber
        Answer: A delayed union occurs when callus forms at a slower than expected rate. This differs from a nonunion that occurs when healing fails to progress and no further healing is expected. Code a delayed union using the ICD-9 code for the fracture because a fracture is still present. In this case, 812.21 (fracture of humerus; shaft of humerus) and 812.00 (fracture of humerus, upper end, unspecified part) should be reported. For the surgical procedure, report 24516 (open treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws). 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 service) and request an increased level of reimbursement. This will require submission of strong supporting documentation with the claim.