Omy13
Contributor
I was looking at CPT 24546 and 24579? Anyone know what is the correct way to code this?
Bicondylar distal humerus fracture with comminuted medial and lateral epicondyle fractures
Indications:
27 y.o. female with history, physical examination, and imaging findings consistent with Left distal humerus fracture operative and nonoperative options were discussed with her in my office and we ultimately agreed that surgical intervention would provide the highest likelihood of union and return to normal activities. The patient was indicated for distal humerus open reduction internal fixation. I drew diagrams outlining general surgical principals. The risks and benefits of surgery as well as the postoperative rehabilitation plan were reviewed. She voiced a good understanding of treatment options, risks and benefits, and alternatives to surgery. She was given the opportunity to ask questions, which were all answered to the best of my ability and to her satisfaction. she wished to proceed.
PROCEDURE:
On the day of surgery, the pt was seen in the preoperative area. I confirmed her identity by name and birthday. We reviewed and confirmed the surgical consent including laterality. The surgical site was identified and marked with my initials. We re-reviewed the risks and benefits of the procedure and I answered all additional questions to her satisfaction.
Suzanne was taken to the operating room in stable condition. After induction of anesthesia, she was placed in a lateral position with an arm holder supporting the operative limb and a non-sterile tourniquet was placed. The upper extremity was prepped and draped in a standard, sterile fashion.
A surgical time out was performed where I confirmed the operative site, reaffirmed the consent, noted appropriate imaging studies were in the room, and that preoperative antibiotics had been given within recommended timeframe prior to skin incision. A sterile esmarch was used to exsanguinate the upper extremity and inflated to 250 mmHg.
A 10 cm incision over the posterior aspect of the elbow was marked and the skin was incised. Dissection was carried out through subcutaneous tissue. Crossing superficial vessels were ligated. The fascia overlying the triceps was incised and the triceps was mobilized off the posterior aspect of the humerus. The ulnar nerve was carefully mobilized out of the cubital tunnel and protected with Vessel loops throughout the case. Sharp dissection was carried over the medial epicondyle staying on bone to prevent any soft tissue injury. Medially the fracture site was identified, hematoma and soft tissue interposed in the fracture site was removed. The medial fracture fragment was mobilized, reduced and provisional fixation in the form of a K wire was placed. We then turned our attention to the lateral side. Sharp dissection was carried over the lateral epicondyle staying on bone to prevent any soft tissue injury. Laterally the fracture site was identified, hematoma and soft tissue interposed in the fracture site was removed. The lateral fracture fragment was mobilized and reduced.
We then returned back to the medial side and a Synthes 72 mm stainless steel medial distal humerus plate was contoured to the medial column. While protecting the ulnar nerve with gentle retraction, the most proximal hole a 3.5 cortical screw was inserted to compress the plate to bone. We then drilled and inserted locking 2.7 millimeter screws in the 3 most distal holes. Finally a 2.7 cortical screw was inserted for additional fixation proximal to the primary fracture line.
Then returned back to the lateral aspect of the elbow and a 69 mm stainless steel lateral distal humerus plate was contoured to the lateral column. The lateral epicondyle fracture was reduced and clamped with a point-to-point reduction clamp and held in place with a K wire for provisional fixation. In the most proximal hole a 3.5 cortical screw was inserted to compress the plate to bone. We then drilled and inserted locking 2.7 millimeter screws in the 3 most distal holes. Finally a 2.7 cortical screw was inserted for additional fixation proximal to the primary fracture line.
Fluoroscopy was used to confirm that none of the screws breached intra-articularly. Range of motion of the elbow was also assessed to confirm that there were no intra-articular screws.
The tourniquet was let down and hemostasis achieved. The wound was copiously irrigated. Attention was turned to closure with 2-0 Vicryl deep dermal sutures and running subcuticular Monocryl suture. A sterile bulky dressing with the arm splinted in 90 degrees of elbow flexion.
Suzanne was taken to the recovery room in a stable condition with plan for ambulatory discharge to home. She was provided my postoperative discharge booklet, appropriate home exercises.
Bicondylar distal humerus fracture with comminuted medial and lateral epicondyle fractures
Indications:
27 y.o. female with history, physical examination, and imaging findings consistent with Left distal humerus fracture operative and nonoperative options were discussed with her in my office and we ultimately agreed that surgical intervention would provide the highest likelihood of union and return to normal activities. The patient was indicated for distal humerus open reduction internal fixation. I drew diagrams outlining general surgical principals. The risks and benefits of surgery as well as the postoperative rehabilitation plan were reviewed. She voiced a good understanding of treatment options, risks and benefits, and alternatives to surgery. She was given the opportunity to ask questions, which were all answered to the best of my ability and to her satisfaction. she wished to proceed.
PROCEDURE:
On the day of surgery, the pt was seen in the preoperative area. I confirmed her identity by name and birthday. We reviewed and confirmed the surgical consent including laterality. The surgical site was identified and marked with my initials. We re-reviewed the risks and benefits of the procedure and I answered all additional questions to her satisfaction.
Suzanne was taken to the operating room in stable condition. After induction of anesthesia, she was placed in a lateral position with an arm holder supporting the operative limb and a non-sterile tourniquet was placed. The upper extremity was prepped and draped in a standard, sterile fashion.
A surgical time out was performed where I confirmed the operative site, reaffirmed the consent, noted appropriate imaging studies were in the room, and that preoperative antibiotics had been given within recommended timeframe prior to skin incision. A sterile esmarch was used to exsanguinate the upper extremity and inflated to 250 mmHg.
A 10 cm incision over the posterior aspect of the elbow was marked and the skin was incised. Dissection was carried out through subcutaneous tissue. Crossing superficial vessels were ligated. The fascia overlying the triceps was incised and the triceps was mobilized off the posterior aspect of the humerus. The ulnar nerve was carefully mobilized out of the cubital tunnel and protected with Vessel loops throughout the case. Sharp dissection was carried over the medial epicondyle staying on bone to prevent any soft tissue injury. Medially the fracture site was identified, hematoma and soft tissue interposed in the fracture site was removed. The medial fracture fragment was mobilized, reduced and provisional fixation in the form of a K wire was placed. We then turned our attention to the lateral side. Sharp dissection was carried over the lateral epicondyle staying on bone to prevent any soft tissue injury. Laterally the fracture site was identified, hematoma and soft tissue interposed in the fracture site was removed. The lateral fracture fragment was mobilized and reduced.
We then returned back to the medial side and a Synthes 72 mm stainless steel medial distal humerus plate was contoured to the medial column. While protecting the ulnar nerve with gentle retraction, the most proximal hole a 3.5 cortical screw was inserted to compress the plate to bone. We then drilled and inserted locking 2.7 millimeter screws in the 3 most distal holes. Finally a 2.7 cortical screw was inserted for additional fixation proximal to the primary fracture line.
Then returned back to the lateral aspect of the elbow and a 69 mm stainless steel lateral distal humerus plate was contoured to the lateral column. The lateral epicondyle fracture was reduced and clamped with a point-to-point reduction clamp and held in place with a K wire for provisional fixation. In the most proximal hole a 3.5 cortical screw was inserted to compress the plate to bone. We then drilled and inserted locking 2.7 millimeter screws in the 3 most distal holes. Finally a 2.7 cortical screw was inserted for additional fixation proximal to the primary fracture line.
Fluoroscopy was used to confirm that none of the screws breached intra-articularly. Range of motion of the elbow was also assessed to confirm that there were no intra-articular screws.
The tourniquet was let down and hemostasis achieved. The wound was copiously irrigated. Attention was turned to closure with 2-0 Vicryl deep dermal sutures and running subcuticular Monocryl suture. A sterile bulky dressing with the arm splinted in 90 degrees of elbow flexion.
Suzanne was taken to the recovery room in a stable condition with plan for ambulatory discharge to home. She was provided my postoperative discharge booklet, appropriate home exercises.