proximal humerus w percutaneous pinning

peporter

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Hello coders, I need your help. How do you find a cpt code for a closed reduction of proximal humerus with percutaneous pinning? The sugeon used the code 23615, which is open reduction. The notes say the fracture was reduced and then stab holes were used for the pins. Does this qualify as open? What code is normally used for this? Thanks, Paula:confused:
 

peporter

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op notes added

Hello coders, I decided to add the op note for the surgery. I still need help with a code for this:



The patient was identified in preop holding both verbally and by his
identification tag, transferred to the placed on the OR table in supine
position. Anesthesia gave general anesthetic, secured airway. The
patient's right proximal humerus was then addressed and his arm was
prepped and draped in sterile fashion. Right arm was elevated and
reduction was performed. Acceptable reduction was seen in 2 views. A
2-0 Steinmann partially threaded pin was placed and placed across the
fracture site and prior to the phthisis. Acceptable reduction was seen.
He had stability. another Steinmann pin was made a stab hole anterior
to this and through the stab hole Vita-Gel was placed in the fracture
site for bone healing potential and hemostasis. The patient was stable
with the one Steinmann pin throughout range of motion, both in the AP
and lateral views. At this point, the Steinmann pin was bent, cut, and
pin cap was placed. Xeroform was placed around a sterile dressing
applied. He was transferred to PACU in stable condition. He
will be discharged to follow-up with me in 10-14 days. Keep the
immobilizer on and to be followed orthopedically outpatient.
 

mbort

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I would agree with the 23605 since there is pinning involved. Unfortunately because he used the word "stab" rather than "incision", he can not capture an open repair.
 

peporter

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Thanks for the help, I wasn't sure the traction code could be used the same as the percutaneous pinning. I really appreciate all the help I get from the coders in this forum. You're the greatest! Thanks again, Paula:)
 
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I just got to this form of diagnosis while doing the Practicode. The clinical report mentioned anesthesia, percutaneous pins, and X-rays. When I got the report corrected, the answers mentioned not to include the three. Why is this so? When exactly would I mention the anasthesia and X-rays for a reduction surgery?
 

AlanPechacek

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What was done here was a Closed Manipulative Reduction of a Closed Fracture of the Proximal Humerus with Percutaneous Pin Fixation, with X-ray imaging of the fracture reduction and the placement of the pin fixation. This could not be done without some form of general anesthesia, provided by an Anesthesiologist &/or CRNA. Their charges are separate from the Surgeon's charges for their professional work, plus a facility fee for the OR and Anesthesia Equipment. The Operative Procedure includes all the work done by the Surgeon including the use of the X-ray to monitor the reduction and guide the placement of the pin fixation. These are an "integral" part of the procedure. Since there was no incision to expose the fracture itself, the Stab Wounds made for the pin placement do not make it an "open" procedure.

There is no specific CPT Code for this particular procedure. The closest is 23605 since it covers closed manipulative reduction, but strangely includes the possibility of applying Skeletal Traction (which requires placement of a metal pin through the humerus at some point other than the fracture site) or Skin Traction (doesn't require a pin anywhere the bone). For practical purposes, Skeletal Traction for a proximal humeral fracture is not used any more, and I can't figure out why it is still in the Descriptor. You might be able to use 23605 plus Modifier 22: Increased Procedural Service (for the placement of the pin fixation under X-ray guidance). About the only other possibility would be 23929: Unlisted procedure, shoulder. You would need to send the Operative Report (at least) for supportive documentation.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com
 
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