New Hartford, NY
Best answers
Good afternoon, coding gurus! :p
I have a coding question I need some help with. Working with hand patients for quite some time, I think I have the Open vs. Closed Reduction definitions figured out. However, the question I have today is this: If a patient has a traumatic injury sustaining an open fracture and the surgeon reduces this fracture gaining access through the open wound caused by the trauma and not through his own incision, is it considered open or closed reduction? The opening created by the trauma, exposing the fracture, required a 3cm closure to repair the soft tissue after reduction of the fracture (13132). CPT 26746 is how the OP note was initially coded. Should it be changed to 26470? I reviewed this with our surgeon, who is a hand specialist. He states he understood an open fracture reduction could be coded as such, either if he made the incision to gain access or the trauma caused the area to be open. Any ideas? Thanks so much for your help!

I would code 26746.

A closed reduction is accomplished by applying traction at or across the fracture to relax and lengthen the muscles then manipulating the bone fragments back into position and holding this newly achieved position with a cast or splint. No skin incision is required in the closed reduction procedure. Although many fractures are reduced using sedation or local or regional anesthesia in an emergency department or physician office, some individuals must be given general anesthesia in the operating room in order to provide pain control and muscle relaxation.

An open reduction involves the same concepts but is done as a surgical procedure for fractures that cannot be reduced or held in reduced position by closed reductions. Usually internal fixation of the fracture is performed during the same operation as the open reduction. Open reductions are also necessary to treat an open fracture or compound fracture, as open wounds must be cleaned, dead tissue and foreign material removed (débridement), and then repaired.
Thank you Armen, that is how it is coded right now. Someone told me they felt this was incorrect, so I am here in our forum tryuing to get some other unbiased opinions. Thanks so much for your help and response! :)
I feel if you bill for an open reduction the repair of the wound will be denied as inclusive, the wound is incidental to the accident, therefore to get the most reimbursements a closed reduction with repair of the wound 59 modifier I feel is the correct way to go. If an open reduction was not necessary and it was only there because of the wound, it should not be coded as open. my opinion
Per the CPT book

Open Treatment is used when the fractured bone is either: (1) surgically opened (exposed to the external environment) and the fracture (bone ends) visualized and internal fixation may be used; or (2) the fractured bone is opened remote from the fracture site in order to insert an intramedullary nail across the fracture site (the fracture site is not opened and visualized).