Wiki Non union fx Tibia w/bone marrow aspiration

[cmacpc]

Good Morning:
In need of some help with this case:
This is the fourth surgery since 11/28/16 and has some comorbidities, Vit D dificiency, uncontrolled Diabetes, non compliance.

I have a case that I am trying to code it is as follows:

There is also the adjustment of the exfix which is not dictated on the op report 20693 ( have requested addendum)

I then made a new anterolateral incision. I performed soft tissue dissection. Hemostasis to the nonunion site. I then used multiple curettes and fluoroscopy to aggressively curette out the site of nonunion. After this, I then aspirated about 15-20ml of bone marrow from the superior iliac spine. I did inject this into the non union site. Then closed the wound in layers.

At this point, sterile dressing was applied. Then using fluoroscopy, I compressed the fracture by about 8 mm. The fracture was still very well aligned. She underwent reversal of anesthesia and was transferred out of the OR in stable condition.

I came up with 20693, 38220, or 10021,76000-26 (but what about injecting) not sure if I can bill for takedown of tibia?

Would appreciate any thoughts
TIA: confused:

 

[AlanPechacek]

This is a tricky case to code. Essentially your physician did an Open Treatment of a Tibial Nonunion with a "Bone Marrow" Graft, (as opposed to a "Traditional" Bone Graft harvested from elsewhere (usually the Iliac Crest)), and using a "Compression Technique." This is covered by Code 27724. The "exceptions" to this procedure as described/defined in CPT is the use of a Bone Marrow Graft instead of a "Traditional" Bone Graft (the obtaining of which is included in the procedure descriptor), and the "Adjustment" of the External Fixator which amounted to the "I compressed the fracture by about 8 mm." which is the same as providing "Compression." The next question is whether 38220: Bone Marrow Aspiration, only, which applies to it's use as a Bone Marrow Graft, can also be listed as a separate/additional code/charge? The Bone Marrow Graft is obtained by Aspirating the Bone Marrow material, which is a liquid, into a syringe. It is kept in the syringe until used/placed into the nonunion site. Since it is a Liquid in a syringe, it has to be "injected" from the syringe. This would be covered by 38220, and not a separate procedure or code (10021). Also at issue is whether his "compression" of the nonunion site at the end by "adjusting" the External Fixator is truly a separate/additional procedure for which a separate code (20693) can be added? I would doubt it. Also, he did not appear to make any "adjustments" to correct alignment other than the "compression." The 76000 code for Fluoroscopy is kind of "iffy" too. I would tend to consider it a part of the overall procedure as it was used to monitor the "compression" of the nonunion, as opposed "direct vision/observation" of the nonunion site when the "compression" was applied. It would be wise for you to check the NCCI Edits for the procedures you are considering, but my best "guess" is that 27724 code will include (bundle) all of these different elements of his procedure into one. The other
"option " is to submit all of them with appropriate Modifiers and see what happens. Good luck with that though.

I would be interested to see what others say.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com