Wiki Non-union fibular fracture

[karen.lebens@parknicollet.com]

Hello, I'm having a tough time deciding which way to code this non-union fracture repair.
Patient is 6 weeks out from a fall, had fractured ribs and an ankle, the ribs were more painful so he delayed seeking any treatment.
Seen in clinic on 4/4/22, x-rays show a non-union fracture. Now coming in for fracture repair, doctor removes the interposed soft tissue at the nonunion site with a small rongeur and the edges of the bone are freshened. In the description I'm reading for repair it says the doctor has to perform an osteotomy, I didn't see that in the note, should I query the doctor on this?

Since they say "nonunion" do I code it to 27726 (repair of fibula nonunion and/or malunion with internal fixation)
Or, do I code it to 27792 (Open treatment of distal fibular fracture, including internal fixation)

I remember hearing that if you code it to the nonunion it implies that it was fixated in the past, but now that issue is being challenged.
Most of the time when I have coded nonunion cases there has been prior fixation done so that needs to be taken out.

 

[amyjph]

The 27726 doesn't specify an osteotomy has to occur, there is an includes note that it includes (cant separately report) fibula osteotomy. Not sure where you are reading that? Nonunion means it's not healing between fractured bone parts. It doesn't necessarily mean it was a failed fixation, although that's usually why. If the patient sought care in a delayed fashion it could be a nonunion, another could be they attempted non-operative treatment and it failed, Most times it is due to failure of fixation, smoking, osteoporosis, poor bone quality, etc. If the provider called it a nonunion and the procedure is a repair of the fibula nonunion w/ internal fixation = 27726 in my opinion. I have heard arguments that being only 6 weeks out you should use the ORIF codes. The nonunion codes carry more RVU.

 

[karen.lebens@parknicollet.com]

Thank you for the reply. The resource I was looking at was the coding essentials book put out by the AMA and in that description they talk about doing as osteotomy, but that may fall under the "malunion" more so than the "nonunion". I'm learning as I go in the coding world, so again thank you for taking the time to respond to the question.