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Thread: new coder needs HELP

  1. #1

    Default new coder needs HELP

    AAPC: Back to School
    Confused on CPT and ICD9. Looking at 27236 vs 27248 and ICD9 820.03

    Any help is appreciated.

    procedure: ORIF hip

    diagnosis: fracture of the hip base of the neck with intertrochanteric extension hip.

    op note reads: An incision was made just superior to the greater trochanter. Dissection was carried through the fascia to the underlying musculature which was bluntly divided down to the tip of the greater trochanter. The DePuy trochanteric nail system was used. A guidewire was placed at the tip of the greater trochanter under fluroscopic control and passed distally under AP and lateral fluoroscopic views. The greater trochanteric area was reamed over the guidewire. A short trochanteric nail size 10-mm nail, which was passed through the reaming of the greater trochanter under fluroscopic control and was positioned and a proper alignment with the head and neck. A second small incision was made aligning with the alignment device for passing the guidewire into the head and neck. The guidewire was passed, fluroscopic showed excellent positioning. Over the guidewire the head and neck were reamed down to subchrondral bone. A 90-mm helical blade of Synthes was passed under fluroscopic control to the appropriate subchondral bone level of the head. Positioned and what seemed to be excellent AP and lateral views. A third incision was made through which the guide system for the locking nail was placed. After dividing soft tissue the lateral femoral shaft was reamed and a 30-mm locking screw was placed. Fluroscopically we completed the procedure after removing the guides showed the fracture reduced and components in excellent position in two views. Over a medium Hemovac tube the larger upper incision was closed. The fascia was closed #0 Vicryl and the subcutaneous was closed with 2-0 Vicryl. The skin was stapled. Similar closure was carried out on the two small distal incision.
    Last edited by ggparker14; 01-13-2011 at 12:54 PM.

  2. #2
    Join Date
    Apr 2007
    Charm City - Baltimore


    I actually think this sounds more like 27245. If you have a Coders Desk Reference, look up each of the procedure you suggest and then check the 27245. This sounds more like what the surgeon did.
    Crystal, CPC, CCS-P

  3. #3


    i agree with the 27245.

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