Periprosthetic Fracture Femur-Vancoover B

kathy a

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Having problems coding a surgery in which the patient had an ORIF of her left femur-she had a total hip replacement a month previous and had a prosthesis put in, so she no longer has her trochanters.Her diagnosis is peri-prosthetic fracture involving her prosthesis. Doctor replaced her prosthesis. Would you code this as an unlisted code? I have done research on this and the codes suggested to use were :

# 27236-which the doctor says is all wrong due to the type of prosthetic used.
He suggested # 27507- which I told him it was the shaft, which the break wasn't there, as it was around the proximal end, where the prosthesis was-so that would be incorrect.
I have seen where people have used # 27244- he said that would be closer-since he used a plate. This code states intertrochanteric, peritrochanteric, or subtrochanteric with plate/screw type implant.The problem is that she doesnt have any trochanters.
Any help would be greatly appreciated.
Kathy Albert,CPC:confused:
 

hewitt

Expert
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It seems to me that your better (not best) choice is to use the closest CPT for what he has documented with an appropriate modifier. The appropriate ICD-9 codes would help clarify as well. Otherwise, the unlisted code may be your other option. This may not be the answer you were looking for, but you are in a tight spot. :)
 
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