We are trying to figure out the diagnosis coding for the orthopedic surgeons who were called in to do fracture repair in this scenario:

A patient who was 8 months pregnant w/twins was in involved in a severe head-on MVA resulting in multiple fractures and injuries including uterine rupture and the loss of the twins at 8 months gestational age. The initial surgical team was composed of trauma and obstetric surgeons and they emergently performed a laparotomy, splenectomy, uterine repair and delivery of the deceased twins. The orthopedic team then proceeded to treat the multiple fractures.

While it is true that the patient was no longer pregnant by the time the orthopedic surgery team stepped in to repair the fractures....

It is our opinion that since the orthopedic repairs were dependent upon the decision from the trauma and obstetric teams that the patient was stable enough to undergo the additional surgery, the other injuries did play a role in the management of the patient by the orthopedic surgeons. In this case, the patient went emergently to the OR for splenectomy and repair of the traumatic uterine rupture. Immediately following closure of the abdomen, the orthopedic team stepped in to do their surgeries which included fracture fixation and reduction of a pelvic dislocation. The patient did not leave the OR and remained under anesthesia for the entire time.

The orthopedic surgeon was very clear in his documentation that the injuries which had been treated by the surgical teams in the room ahead of him played a significant role in his management of the patient.


Patrick and Margaret