pandora71968
New
Need help with CPT code for Drilling femoral head for ischemia necrosis. The op report reads
Preop Dx: Ischemic necrosis, right femoral head
Postop Dx: Ischemia necrosis, right femoral head
Op Procedure: Drilling, right femoral head
Indications: The patient is a 66-year-old male with the diagnosis noted above. Treatment options were reviewed and I recommended the above procedure. Anticipated benefits of surgery as well as potential complications of surgery and anesthetic were reviewed in detail and he appeared to understand all matters discussed and wished to proceed.
Op Procedure:
The patient was brought to the operating room. The time-out procedure was followed. General anesthesia was induced. He was placed in the supine position on the fracture table. The right foot was secured in the leg holder. The hip was imaged with C-arm in both AP and lateral planes and the area of necrosis of the femoral head was identified. The right hind quarter was prepped and drapes applied. A longitudinal incision was made in the subtrochanteric region of the femur. Under fluoroscopic control, a guide wire was advanced into the necrotic area. A cannulated drill from the compression hip screw set was advanced under fluoroscopic control to the base of the lesion. Care was taken not to violate the hip joint space. A pituitary rongeur was used to perform a biopsy of the necrotic area. Only a limited amount of bone was obtained. The wound was irrigated. A layered anatomic closure was performed using Vicryl. Skin closure was with staples. The skin was infiltrated with Marcaine. A soft dressing was applied. The patient was transported to the recovery room in stable condition. There were no intraoperative or immediate postoperative complications. Estimated blood loss was less than 20 cc.
What code would be used for the drilling of the femoral head? Would 27170 Bone graft, femoral head, neck, intertrochanteric or subtrocanteric area (includes obtaining bone graft) be a possibility? Really could use some help.
Janet Miller, CPC
Preop Dx: Ischemic necrosis, right femoral head
Postop Dx: Ischemia necrosis, right femoral head
Op Procedure: Drilling, right femoral head
Indications: The patient is a 66-year-old male with the diagnosis noted above. Treatment options were reviewed and I recommended the above procedure. Anticipated benefits of surgery as well as potential complications of surgery and anesthetic were reviewed in detail and he appeared to understand all matters discussed and wished to proceed.
Op Procedure:
The patient was brought to the operating room. The time-out procedure was followed. General anesthesia was induced. He was placed in the supine position on the fracture table. The right foot was secured in the leg holder. The hip was imaged with C-arm in both AP and lateral planes and the area of necrosis of the femoral head was identified. The right hind quarter was prepped and drapes applied. A longitudinal incision was made in the subtrochanteric region of the femur. Under fluoroscopic control, a guide wire was advanced into the necrotic area. A cannulated drill from the compression hip screw set was advanced under fluoroscopic control to the base of the lesion. Care was taken not to violate the hip joint space. A pituitary rongeur was used to perform a biopsy of the necrotic area. Only a limited amount of bone was obtained. The wound was irrigated. A layered anatomic closure was performed using Vicryl. Skin closure was with staples. The skin was infiltrated with Marcaine. A soft dressing was applied. The patient was transported to the recovery room in stable condition. There were no intraoperative or immediate postoperative complications. Estimated blood loss was less than 20 cc.
What code would be used for the drilling of the femoral head? Would 27170 Bone graft, femoral head, neck, intertrochanteric or subtrocanteric area (includes obtaining bone graft) be a possibility? Really could use some help.
Janet Miller, CPC