randiroyder
Networker
HI, I work at a pediatric specialty hospital. My doctor is a pedi orthopaedic. He did a surgery for a nonunion of the right medial malleolus. Here is part of the operative report.
"created a 1-inch longitudinal incision directed over the medial malleolus and spread the soft tissues protecting the saphenous nerve and vein. We identified the periosteum overlying the medial malleolus and using a probe tried to demonstrate gross motion of the medial malleolus but there was really no motion that was perceptible grossly. We therefore made the decision not to expose the fracture as per our preoperative plan and then we used guidewires for the 3-0 cannulated screw and tried to place these perfectly parallel to the physis and subchondral bone within epiphysis. We used AP and lateral fluoroscopy to position both guidewires that were felt to be well placed on both views and then over-drilled with the drill and placed 30-millimeter 3.0 partially threaded cannulated screws. There was good sense of excellent screw purchase un the epiphyseal bone and satisfying bite to the screws for both of them."
Our coder chose 27762- Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal traction.
Our physician said he did, 27766-Open treatment of medial malleolus fracture, includes internal fixation, when performed
with a little more research the auditor and I chose 27720-Repair of nonunion or malunion, tibia; without graft,
But if you look at code 27720 it says "To correct nonunion of the tibia, the physician makes an incision on the medial aspect of the tibia through the periosteum. The bone is divided by transverse cuts and the pieces are manually rotated into position and stabilized with a metal plate and screws. The wound is closed, dressed, and a cast is applied."
The doctor did all the above except for exposing the bone and cutting the bone. So we are not sure what code is the correct one or if we are even looking at the correct code.
Please, any suggestions or help with this.
Thanks
"created a 1-inch longitudinal incision directed over the medial malleolus and spread the soft tissues protecting the saphenous nerve and vein. We identified the periosteum overlying the medial malleolus and using a probe tried to demonstrate gross motion of the medial malleolus but there was really no motion that was perceptible grossly. We therefore made the decision not to expose the fracture as per our preoperative plan and then we used guidewires for the 3-0 cannulated screw and tried to place these perfectly parallel to the physis and subchondral bone within epiphysis. We used AP and lateral fluoroscopy to position both guidewires that were felt to be well placed on both views and then over-drilled with the drill and placed 30-millimeter 3.0 partially threaded cannulated screws. There was good sense of excellent screw purchase un the epiphyseal bone and satisfying bite to the screws for both of them."
Our coder chose 27762- Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal traction.
Our physician said he did, 27766-Open treatment of medial malleolus fracture, includes internal fixation, when performed
with a little more research the auditor and I chose 27720-Repair of nonunion or malunion, tibia; without graft,
But if you look at code 27720 it says "To correct nonunion of the tibia, the physician makes an incision on the medial aspect of the tibia through the periosteum. The bone is divided by transverse cuts and the pieces are manually rotated into position and stabilized with a metal plate and screws. The wound is closed, dressed, and a cast is applied."
The doctor did all the above except for exposing the bone and cutting the bone. So we are not sure what code is the correct one or if we are even looking at the correct code.
Please, any suggestions or help with this.
Thanks
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