Wiki How to bill percutaneous intra-articular proximal phalanx head fracture

[jvanek82]

Hi. Can anyone help with what code would be used for this surgery? There is no percutaneous code!

Procedure Details: Patient was identified in the preoperative holding area and the operative site was marked. Risks and benefits of the surgery again were discussed. Risks included but not limited to bleeding, infection, damage to adjacent structures, stiffness, pain, loss of function, incomplete recovery, malunion, nonunion, hardware irritation, and need for additional surgery. Patient and family verbalized understanding and wish to proceed.

The patient was taken back to the OR and underwent anesthesia without complication. The right upper extremity was prepped and draped in the usual sterile fashion. A time-out occurred immediately prior to procedure identifying the correct patient, site, laterality, planned procedure, preoperative antibiotics, availability of equipment and availability of imaging. The arm was exsanguinated the tourniquet was insufflated to 250 mmHg. Initial fluoroscopic imaging demonstrated impacted fracture along the ulnar condyle of the right ring finger proximal phalanx head. On the lateral radiograph, there is more dorsal displacement of the impacted fracture. Traction was applied about the digit along with radial deviation through the PIP joint. Volarly directed pressure was applied about the proximal phalanx head. Orthogonal fluoroscopic imaging demonstrated concentric alignment of the intra-articular proximal phalanx head fracture. While holding reduction, a 0.045 K-wire was inserted in a retrograde fashion from the ulnar condyle to the radial condyle. K-wire was cut. Orthogonal fluoroscopic imaging demonstrated maintained reduction and appropriate K-wire positioning. Ring finger was brought through range of motion. No further scissoring. K-wire was then bent and further cut to size and Jurgan ball was applied. 10 cc of local anesthetic was injected about the right ring finger for digital nerve block. Sterile dressing consisting of Xeroform, 4x4s and Webril was applied. Patient was placed into a ulnar gutter splint with the inclusion of small and ring finger.

Thanks for any help!!

 

[NRaizman]

We typically use 26727, which doesn't distingish articular or not.
N.

 

[jvanek82]

We typically use 26727, which doesn't distingish articular or not.
N.

Thank you for this information. This is the code I suggested, however the provider disputed it saying the correct code would be 26746 because it was articular. He referred to a hand-out from Eaton for his reasoning. Do you have any supporting documentation as to using 26727?

 

[NRaizman]

Charlier Eaton has long retired from hand surgery practice, and has not updated his site in years.
Even when it was updated, it was just a collection of codes he used and has no connection whatsoever to the coding community, ASSH, AAOS, or CPT.
There is no world in which it carries any weight. It never has.

If you don't document making an incision, you cannot call it "open". Period. You can refer him to the CPT manual and NCCI Policy Manual on that one.
We use the ORIF code all the time for this type of surgery, and CPT changed their definition to note that "open" doesn't require the reduction to be visualized. This allows us to code ORIF for minimally invasive fixation of phalanges and metacarpals using threaded nails.

The important thing is that, IF YOU DON'T MAKE AN INCISION AND DOCUMENT IT, you can't bill for it.It can be a small stab incision, but you need to document that you made an incision and dissected, bluntly or sharply, down to the bone. It helps to describe this in more detail than necessary to make sure the open code is documented. Your provider has left RVU's on the table because he did not document the surgery well.

 

[jvanek82]

Charlier Eaton has long retired from hand surgery practice, and has not updated his site in years.
Even when it was updated, it was just a collection of codes he used and has no connection whatsoever to the coding community, ASSH, AAOS, or CPT.
There is no world in which it carries any weight. It never has.

If you don't document making an incision, you cannot call it "open". Period. You can refer him to the CPT manual and NCCI Policy Manual on that one.
We use the ORIF code all the time for this type of surgery, and CPT changed their definition to note that "open" doesn't require the reduction to be visualized. This allows us to code ORIF for minimally invasive fixation of phalanges and metacarpals using threaded nails.

The important thing is that, IF YOU DON'T MAKE AN INCISION AND DOCUMENT IT, you can't bill for it.It can be a small stab incision, but you need to document that you made an incision and dissected, bluntly or sharply, down to the bone. It helps to describe this in more detail than necessary to make sure the open code is documented. Your provider has left RVU's on the table because he did not document the surgery well.

Thank you Dr. Raizman for this information. I appreciate your help.