Coding an impending Fx and procedure

1073358

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My doc did a surgery on a patient who has dx of metastatic breast cancer, left pathologic intertrochanteric fx and impending fx on right femur.

Any suggestions on how to DX the impending FX on the right leg? He did an intramedullary rodding of both femurs.
 

Frosty

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I'd use 198.5 (2ndary malig.neoplasm, bone & bone marrow) for the one w/out the fx & use 733.14 & 198.5 for the one with the fx. Also, I'd use proc 27187 or 27495 (prophalactic txmt) for the sx on the one leg since there wasn't actually a fx. (& depending whether it was neck or shaft). That's my opinion.
 
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There is nothing that states the patient has bone marrow cancer, I would use the metastatic BREAST CANCER with the pathalogical fracture as the primary since it is impending. I wouldn't attach a secondary neoplasm code unless the Dr specifically states that the patient has cancer in the bone and bone marrow...
 
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