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2nd request, please help if you can :0)

  1. #1
    Default 2nd request, please help if you can :0)
    Medical Coding Books
    Hello super Ortho coders! It's like learning Greek! I'm new to ortho, so help is greatly appreciated.

    Here's the codes I'm thinking, but I'm really not sure, and I'm not sure if I need to use 2 codes, or if it's all covered in one. I get 25515, and 25350, or 25355, I'm not sure on either one of those.

    The op report states that the procedure performed is : Open reduction and osteotomy of the radial shaft fracture using 5-hole LC-DCP plate.

    The procedure notes say this in part: Incision made along the proximal volar forearm adjacent to the brachial radialis down to the radial shaft protecting the radial nerve identifying the bowing of the fracture, as well as the initial fracture itself, for which osteotome and saw was used to perform osteotomy to allow the radius to lay down straight without angulation in AP and lateral plane, and to reestablish the radial bow. A 5-hole plate was applied with compression at the site with 3.5 cortical screws providing stable fixation with full forearm pronation, supination without evidence of fracture movement. Irrigation after this was performed.

    Thanks for the help in advance!

  2. Default
    since it says in the first line proximal. I think this should be coded as 25515 and 25355.

  3. #3
    Default Thanks!
    Thank you so much! I wasn't sure which code the proximal fell into, do you have any resources on that kind of thing? I literally feel like I'm flying blind. I'm just excited I even got close! I really appreciate the help.

  4. Default
    Quote Originally Posted by JenReyn99 View Post
    Thank you so much! I wasn't sure which code the proximal fell into, do you have any resources on that kind of thing? I literally feel like I'm flying blind. I'm just excited I even got close! I really appreciate the help.
    Hey good job then on picking the codes!!
    Well, the 25350 is for distal only and the 25355 is for middle or proximal and since the doctor made the incision proximal that's why I went with that one. I just went by the CPT book and the coders desk reference book.

  5. #5
    Default
    My description of 25515 does not show that it includes an osteotomy. So, I would charge both codes. However, I really cannot tell exactly where the osteotomy was made, but I am leaning more towards the 25355 based on the incision, but I would ask my doc exactly where it was made.

  6. #6
    Default
    Thank you both very much, your input was extremely helpful!

  7. #7
    Default
    I'm coming a little late to this party, but what was the diagnosis code?

  8. Default
    The description of 25515 "Open TREATMENT of radial shaft fracture ,includes internal fixation when performed." The term treatment then means the management of the whole lot of components in its way in treating the fracture, meaning the osteotomy which is necessary in this procedure becomes a part of it in the treatment.
    So I feel that the code 25515 itself suffice. well, if the Surgeon had to spend more time and work, then can append modifier-22 for the increased Porcedure.
    Moreoever, the fracture and bowing has occured in the same bone Radius, not involvimg the ulna (As I read from your op notes). When it occurs so, the correction of angulation in bowing has to be done, otherwise it would hinder the reduction ; not only that, the pronation and supination limitation are to be avoided by correcting the bowing.
    So it involves the whole lot of treatment in this code. but obviously there had been increased work and time spent on this procedure.So I feel appending a modifier 22 is ideal.
    Is there anyone who could agree with me??!!
    Last edited by preserene; 11-08-2010 at 10:21 PM.

  9. Default
    Diagnosis Code Fracture SHAFT RADIUS ALONE- open 813.31. I do not want to assume the fracture is proximal or distal. The shaft covers the middle third fully practically.. Physician notes say the "fracture Shaft"
    Last edited by preserene; 11-08-2010 at 10:42 PM.

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