pwebbabshire@cox.net
Networker
- Messages
- 81
- Location
- Breaux Bridge, LA
So, if a patient has these two fractures and the angle fracture is fixed with ladder plate, mmf wires and the arch bar was left on, I am looking at 21462.
The right body fracture- Placed in MMF, secured with a plate, screws, erik arch bars. At the end of the case the Dr. States that the arch bar was left on as a tension band. Does not state if the arch bar was left on for the right side, just makes that one statement about "arch bar was left on as a tension band". Would I be able to code 21462 twice as: 21462-LT, 21462-RT for the cpt codes?
Thanks,
An incision was made in the right gingivobuccal sulcus over the fracture line. The incision was
deepened into the muscle and then down to the level of the bone. The mental nerve was identified and
protected. A number 9 elevator was then used to elevate all of the soft tissue from the bone down to
the inferior line. The fracture line was cleaned and any callus removed. Attention was then turned to the
left mandible. An incision was then made over the fracture in the gingivobuccal sulcus and deepened to
the level of the bone. The soft tissue was elevated off of the bone and adequate expose of the fracture
achieved. Both fractures were significantly displaced and somewhat comminuted.
Attention was then turned to the maxilla. A hybrid bar was then secured to the maxilla with a total of 5
screws. Care was taken to avoid all tooth roots. Attention was then turned to the mandible. Given that
the fracture passed though the teeth the decision was made to proceed with Erik arch bars. Starting in
midline and working laterally an arch bar was attached with 24 gauge wire.
With the significant displacement of the body fracture there was a laceration of the gingiva and mucosa
that extend into the floor of mouth. At this point in the case the flor pf mouth laceration was closed in an
interupted fashion with a chronic gut suture.
Once both arch bars were in place his teeth were aligned based on ware facets and he was secured in
MMF with 24 gauge fish wire. Once he was placed in MMF attention was turned to the body fracture.
The body fracture was secured with a 3x3 plate with a spacer. The plate was bent to match the contort
of the mandible. The drill was then used to drill bi-cortical holes for screws and the depth gauge used to
determine screw length. The plate was then secured to the mandible in this fashion. A total of 6 screws
were used. One bone screw and two locking screws were used on either side of the fracture.
Attention was then turned to the left angle fracture. A 10 hole ladder plate was then brought onto the
field. The decision was made to place a trocar for better access. An 18 gauge needle was passed
through the cheek to confirm a good location. An incision was then made in the skin and the trocar
passed through the cheek. The ladder plate was then secured to the mandible with 8 monocortical
screws with two holes left open spanning the fracture. A pilot hole was drilled for each screw using the
drill. After both plates were secured the MMF wires were removed and the mandible articulated. The
mandible mobilized well and he was in a reproducible occlusion based on ware facets. The trochar was
removed and the trocar side closed with a fast gut suture. Given the gingival and floor of mouth
laceration the decision was made to avoid a tension band given the concern for potential hardware
exposure. The decision was made to leave the arch bar as a tension band.
Thanks,
The right body fracture- Placed in MMF, secured with a plate, screws, erik arch bars. At the end of the case the Dr. States that the arch bar was left on as a tension band. Does not state if the arch bar was left on for the right side, just makes that one statement about "arch bar was left on as a tension band". Would I be able to code 21462 twice as: 21462-LT, 21462-RT for the cpt codes?
Thanks,
An incision was made in the right gingivobuccal sulcus over the fracture line. The incision was
deepened into the muscle and then down to the level of the bone. The mental nerve was identified and
protected. A number 9 elevator was then used to elevate all of the soft tissue from the bone down to
the inferior line. The fracture line was cleaned and any callus removed. Attention was then turned to the
left mandible. An incision was then made over the fracture in the gingivobuccal sulcus and deepened to
the level of the bone. The soft tissue was elevated off of the bone and adequate expose of the fracture
achieved. Both fractures were significantly displaced and somewhat comminuted.
Attention was then turned to the maxilla. A hybrid bar was then secured to the maxilla with a total of 5
screws. Care was taken to avoid all tooth roots. Attention was then turned to the mandible. Given that
the fracture passed though the teeth the decision was made to proceed with Erik arch bars. Starting in
midline and working laterally an arch bar was attached with 24 gauge wire.
With the significant displacement of the body fracture there was a laceration of the gingiva and mucosa
that extend into the floor of mouth. At this point in the case the flor pf mouth laceration was closed in an
interupted fashion with a chronic gut suture.
Once both arch bars were in place his teeth were aligned based on ware facets and he was secured in
MMF with 24 gauge fish wire. Once he was placed in MMF attention was turned to the body fracture.
The body fracture was secured with a 3x3 plate with a spacer. The plate was bent to match the contort
of the mandible. The drill was then used to drill bi-cortical holes for screws and the depth gauge used to
determine screw length. The plate was then secured to the mandible in this fashion. A total of 6 screws
were used. One bone screw and two locking screws were used on either side of the fracture.
Attention was then turned to the left angle fracture. A 10 hole ladder plate was then brought onto the
field. The decision was made to place a trocar for better access. An 18 gauge needle was passed
through the cheek to confirm a good location. An incision was then made in the skin and the trocar
passed through the cheek. The ladder plate was then secured to the mandible with 8 monocortical
screws with two holes left open spanning the fracture. A pilot hole was drilled for each screw using the
drill. After both plates were secured the MMF wires were removed and the mandible articulated. The
mandible mobilized well and he was in a reproducible occlusion based on ware facets. The trochar was
removed and the trocar side closed with a fast gut suture. Given the gingival and floor of mouth
laceration the decision was made to avoid a tension band given the concern for potential hardware
exposure. The decision was made to leave the arch bar as a tension band.
Thanks,