Orthopedic Coding Alert

Question: I have a claim in front of me that is completely bewildering. Notes indicate that the orthopedist treated a patient with “elbow Fx, Monteggia.” What in the world is a Monteggia fracture, and how do I code it?

Montana Subscriber

Answer: According to ebmconsult.com, “The combination of a radial head dislocation with an ulnar fracture is most commonly known as a Monteggia fracture.” After getting confirmation on the fracture, it is vital to get an orthopedist involved immediately to “reduce the radial head dislocation and ulnar fracture… . Failure to treat appropriately can lead to joint instability and inability to supinate and pronate the forearm normally,” ebmconsult.com states.

CPT^® coding: If you’re sure that the orthopedist treated a Monteggia fracture, choose from one of the following codes:

• 24620 — Closed treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulation
• 24635 — Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation, when performed.

ICD-10 coding: Since this is a very specific type of injury, spot-on diagnosis coding is a must. When you see a Monteggia type fracture on a claim, you’re likely to choose from these diagnosis codes:

• S52.271- — Monteggia’s fracture of right ulna
• S52.272- — Monteggia’s fracture of left ulna
• S52.279- — Monteggia’s fracture of unspecified ulna.

If you’re unsure about your payer’s policy on reporting 24620 or 24635, be sure to double-check its diagnosis requirements. It’s quite likely that the payer would require one of the above-listed ICD-10 codes for payment of 24620 or 24635.