deborahcook4040
Networker
The external fixation code is 20692, but for the primary op, I can't used the closed reduction code (27752)because of the incision, but I can't use the open reduction code (27758) because it specifies internal fixation. I can't use 27792 because Medicare requires a code for fracture of the lateral malleolus, which is not actually fractured.
This one has me stumped.
Op report is as follows:
Patient was evaluated preoperatively for the distal third tibial fracture with extension distally in a spiral pattern, near to the level of the articular surface of the distal tibia, but it did not violate the articular surface of the distal tibia. The long spiral portion of the fracture head reduction acheived with traction, rotation, and making a distal skin incision and placing a Cobb subcutaneously under the skin up to the level of the fracture which started at close to the mid-shaft level extending distally. The Cobb was used to help clean out soft tissue and reduce the fracture.
Next, given the amount of soft tissue swelling and blistering at the level of the fibula, it was felt that it would not be safe to make a skin incision due to the risk of infection over the region, therefore it was felt that this would best be treated with an external fixator. A delta frame, multiplane external fixator was applied with 2 proximal tibial pins and a transcalcaneal pin. Once the external fixator was in place, adjustment of the fracture reduction was made with rotation and traction. Due to the level of comminution and butterfly fragment, there was not a complete anatomic reduction acheived. The fixator was tightened in postion; the wound was irrigated and closed.
This one has me stumped.
Op report is as follows:
Patient was evaluated preoperatively for the distal third tibial fracture with extension distally in a spiral pattern, near to the level of the articular surface of the distal tibia, but it did not violate the articular surface of the distal tibia. The long spiral portion of the fracture head reduction acheived with traction, rotation, and making a distal skin incision and placing a Cobb subcutaneously under the skin up to the level of the fracture which started at close to the mid-shaft level extending distally. The Cobb was used to help clean out soft tissue and reduce the fracture.
Next, given the amount of soft tissue swelling and blistering at the level of the fibula, it was felt that it would not be safe to make a skin incision due to the risk of infection over the region, therefore it was felt that this would best be treated with an external fixator. A delta frame, multiplane external fixator was applied with 2 proximal tibial pins and a transcalcaneal pin. Once the external fixator was in place, adjustment of the fracture reduction was made with rotation and traction. Due to the level of comminution and butterfly fragment, there was not a complete anatomic reduction acheived. The fixator was tightened in postion; the wound was irrigated and closed.