I am coding for a closed reduction for a right displaced subcapital femoral neck fracture with hip pinning. I am not fully sure I am reporting the correct code, but I am looking at choosing 27230 or 27232. I do not see anything in the note about manipulation but is the pinning an additional code as well or would it be included in the procedure? Below is the procedure note, can anyone help me with selecting the correct code?
Preoperative Diagnosis
Right minimally displaced subcapital femoral neck fracture
Postoperative Diagnosis
Right minimally displaced subcapital femoral neck fracture
Operation
Closed reduction and right hip pinning. Physician directed fluoroscopy less than 1 hr.
Findings
Same as postoperative diagnosis. I used the Hana table in over perform a closed reduction of the hip fracture. This demonstrated acceptable reduction with orthogonal views.
Technique
Patient was seen in the preoperative holding area. The correct operative site was marked. Verbal right consent was obtained. He was transferred to the operative suite placed supine operating table. His properly secured to the Hana table and then all bony prominences were well padded. The non operative leg was placed in a well-padded well leg holder. A time-out was performed and all those in attendance were in agreement with the correct operative site and procedure to be performed. The hip was prepped and draped in a normal sterile fashion.
Using fluoroscopy the outline of the femoral neck was marked on the skin and then a 10 blade scalpel used to make a lateral incision approximately 5 cc at length. Prior to the incision local anesthetic was injected including 0.5% Marcaine with epinephrine. The 1st guide pin was then placed to the level of the lateral femur and the level of the lesser trochanter. This was then passed to the femoral head across the fracture site appropriately. Two superior pins were then placed, 1 anteriorly and 1 posteriorly. Fluoroscopy was used throughout with orthogonal views to verify placement of the pins. The pins were then measured utilizing the measuring device over the guide pins. A 100 mm x 7 mm by 16 mm thread screw was placed over the guide pin in the inferior position to secure the fracture. A 90 mm x 7 mm screw was then placed with a short 16 mm thread length over the anterior and posterior superior pins. The screws were then secured on hand power to the lateral femur and found have excellent purchase. Final orthogonal views on fluoroscopy were taken and saved to the chart. Irrigation were used in the incision and then a 2 0 Vicryl was used in a subcuticular fashion to reapproximate the incision. Skin staples were then used to approximate the skin. A sterile Mepilex dressing was placed. All needle and scrubbed counts were correct at the end the case x2.
Preoperative Diagnosis
Right minimally displaced subcapital femoral neck fracture
Postoperative Diagnosis
Right minimally displaced subcapital femoral neck fracture
Operation
Closed reduction and right hip pinning. Physician directed fluoroscopy less than 1 hr.
Findings
Same as postoperative diagnosis. I used the Hana table in over perform a closed reduction of the hip fracture. This demonstrated acceptable reduction with orthogonal views.
Technique
Patient was seen in the preoperative holding area. The correct operative site was marked. Verbal right consent was obtained. He was transferred to the operative suite placed supine operating table. His properly secured to the Hana table and then all bony prominences were well padded. The non operative leg was placed in a well-padded well leg holder. A time-out was performed and all those in attendance were in agreement with the correct operative site and procedure to be performed. The hip was prepped and draped in a normal sterile fashion.
Using fluoroscopy the outline of the femoral neck was marked on the skin and then a 10 blade scalpel used to make a lateral incision approximately 5 cc at length. Prior to the incision local anesthetic was injected including 0.5% Marcaine with epinephrine. The 1st guide pin was then placed to the level of the lateral femur and the level of the lesser trochanter. This was then passed to the femoral head across the fracture site appropriately. Two superior pins were then placed, 1 anteriorly and 1 posteriorly. Fluoroscopy was used throughout with orthogonal views to verify placement of the pins. The pins were then measured utilizing the measuring device over the guide pins. A 100 mm x 7 mm by 16 mm thread screw was placed over the guide pin in the inferior position to secure the fracture. A 90 mm x 7 mm screw was then placed with a short 16 mm thread length over the anterior and posterior superior pins. The screws were then secured on hand power to the lateral femur and found have excellent purchase. Final orthogonal views on fluoroscopy were taken and saved to the chart. Irrigation were used in the incision and then a 2 0 Vicryl was used in a subcuticular fashion to reapproximate the incision. Skin staples were then used to approximate the skin. A sterile Mepilex dressing was placed. All needle and scrubbed counts were correct at the end the case x2.