Question ORIF coronoid , radial head replacement, reudcition elbow dislocation, and debridement

suchang78

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DX:
1. right radial head fx
2. rt coronoid fracture
3. rt elbow dislocation

procedures performed:
1. ORIF right coronoid fracture
2. rt radial head replacement
3. bone grafting, rt elbow
4. debridement, rt elbow

A longitudinal incision was made laterally to the elbow. the lateral muscles were seen. The muscles were split longitudinally, revealing the fracture. Hematoma around the fracture site was evacuated.

The incision was carried down to the bone to allow better visualization of the fractures and to excise any necrotic soft tissue and bone within the fracture region. Cultures of the wound were taken before and after the antibiotic irrigation.

The comminuted coronoid fracture was seen and reduced with pins. A 3.9 cannulated screw was then used to secure the coronoid onto the proximal ulna.

Fluoroscopy was then used to confirm the adequate placement of hardware was well as the adequate reduction of the coronoid in 2 different views.

The comminuted radial head fractures were seen and excised. The fracture end at the radius was cleaned using irrigation, curettes and a rongeur. Using a length marker, the proximal end of the radius was measured to allow room for the implant. A sagittal saw was then used to excise the proximal radius. Broaches were then used in a stepwise fashion. Trial radial stem and head was then removed. A radial stem and head was then impacted into the radius.

The elbow was then manipulated to reduce the dislocation. A threaded pain was then placed through the proximal ulna into the distal humerus to add stability into the joint. The temporary pain was cut short with portion of the pin exposed through the skin.

My codes are
1. 24685 for ORIF coronoid fracture
2. 24666 for right radial head replacement
3. 24615- open reduction for elbow dislocation with pin
4. 11044 - for excise any necrotic soft tissue and bone within the fracture region. Is qualify enough for extensive debridement? or is it included in the radial head replacement?


Please advice.

Thank you
 
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Orthocoderpgu

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The debridement codes that start with 11 like 11044 are for open wounds. When you see that the surgeon had to make an incision in order to perform the procedure you know your not going to be using any of these codes. Any debridement here is just part of the restorative procedure and would not be reported separately.
 

suchang78

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The debridement codes that start with 11 like 11044 are for open wounds. When you see that the surgeon had to make an incision in order to perform the procedure you know your not going to be using any of these codes. Any debridement here is just part of the restorative procedure and would not be reported separately.

Thank you. Surgeon used temporary pin for elbow dislocation and the CPT 24615 doesn't indicate that pin is included in open reduction for dislocation. Is correct to assign 24615 for this case?
 

Orthocoderpgu

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Code 24615 does not hit an edit and the dislocation was reduced. I would say it's supported in the documentation. Pins are almost always taken out at some point anyway. And how its done may be a bit different from time to time. I say your good.
 
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