tschrader
Networker
My doctor is billed these two codes together. I feel that they should not be. Only the 27130 should be billed. Here's an example of the operative report:
Final diagnosis:
100% displaced femoral neck fracture wtih subtrochanteric extension
Procedure performed:
1. Left hip arthroplasty
2. Open reduction, internal fixation femur fracture with subtrochanteric extension
Operative procedure:
A 15 cm incision was made, consistent with a posterolateral approach to the hip. Sharp dissection was carried down through the skin and subcutaneous tissues. Hemostasis was obtained with electrocautery. The Iliotibial band and fascia of the gluteus maximus were split longitudinally. A Charnley retractor was inserted. Care was taken to ensure that there was no injury to the sciatic nerve posteriorly. There was a massive hemarthrosis encountered as soon as I went to the iliotibial band before I entered the hip capsule. After I released the external rotators and posterior hip capsule, hip was dislocated. Femoral neck osteotomy was performed. There was shown to be a fracture of the proximal femur as well circumferentially around the trochanter and extending into the subtrochanteric region on the posterolateral aspect. Next, the femoral head was sized to be 52 mm. Next, attention was turned to the proximal femur fracture. It was held provisionally with a Lowman clamp and then 2 cord cables were placed. Excellent provisional fixation was achieved. Next, an 8-hole cable plate from Smith and Nephew was selected and placed on the proximal fracture, scrured with another six cables and excellent fixation was achieved. next, out attention was turned to the proximal femur. A box ostotome and charnley awl were utilized to enter the femoral canal. Sequential reaming was performed with the echelon hip system beginning with a size 10 and carried up to a size 5. Next, sequential broaching was performed in a similar fashion, a size 12 and carried up to a size 15. multiple head and neck offsets were utilized. the hip was found to be most stable with a standard offset neck. AP pelvis radiograph revealed appropriate positioning of the component and anatomic reduction at the frature site. Next trial component was removed and a size 15 standard offset echelon stem was impacted inot the proximal femur; excellent press-fit was obtained. A 52mm cobalt-chrome femoral head was a -3 neck length was then impacted on the tip of the stem. The hip was relocated. Range of motion was tested and the pt was then closed up.
I would like the opinions of others on this. it was all done in the same area.
Thank you so much for your help!!!
Final diagnosis:
100% displaced femoral neck fracture wtih subtrochanteric extension
Procedure performed:
1. Left hip arthroplasty
2. Open reduction, internal fixation femur fracture with subtrochanteric extension
Operative procedure:
A 15 cm incision was made, consistent with a posterolateral approach to the hip. Sharp dissection was carried down through the skin and subcutaneous tissues. Hemostasis was obtained with electrocautery. The Iliotibial band and fascia of the gluteus maximus were split longitudinally. A Charnley retractor was inserted. Care was taken to ensure that there was no injury to the sciatic nerve posteriorly. There was a massive hemarthrosis encountered as soon as I went to the iliotibial band before I entered the hip capsule. After I released the external rotators and posterior hip capsule, hip was dislocated. Femoral neck osteotomy was performed. There was shown to be a fracture of the proximal femur as well circumferentially around the trochanter and extending into the subtrochanteric region on the posterolateral aspect. Next, the femoral head was sized to be 52 mm. Next, attention was turned to the proximal femur fracture. It was held provisionally with a Lowman clamp and then 2 cord cables were placed. Excellent provisional fixation was achieved. Next, an 8-hole cable plate from Smith and Nephew was selected and placed on the proximal fracture, scrured with another six cables and excellent fixation was achieved. next, out attention was turned to the proximal femur. A box ostotome and charnley awl were utilized to enter the femoral canal. Sequential reaming was performed with the echelon hip system beginning with a size 10 and carried up to a size 5. Next, sequential broaching was performed in a similar fashion, a size 12 and carried up to a size 15. multiple head and neck offsets were utilized. the hip was found to be most stable with a standard offset neck. AP pelvis radiograph revealed appropriate positioning of the component and anatomic reduction at the frature site. Next trial component was removed and a size 15 standard offset echelon stem was impacted inot the proximal femur; excellent press-fit was obtained. A 52mm cobalt-chrome femoral head was a -3 neck length was then impacted on the tip of the stem. The hip was relocated. Range of motion was tested and the pt was then closed up.
I would like the opinions of others on this. it was all done in the same area.
Thank you so much for your help!!!