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27236 or 27138 PLEASE CLARIFY DIFFERENCE

  1. #1
    Question 27236 or 27138 PLEASE CLARIFY DIFFERENCE
    Medical Coding Books
    NOT SURE IF THIS IS 27236 OR 27138

    PLEASE CLARIFY THE DIFFERENCE..THANK YOU

    DIAGNOSIS:
    LEFT FEMUR PREIPROSTHETIC FRACTURE (996.44)

    PROCEDURE PERFORMED:
    COMPLEX REVISION LEFT BIPOLAR HEMIARTHROPLASTY WITH REVISION INSTRUMENTATION (27236 OR 27138)

    WHAT ABOUT REVISION INSTRUMENTATION?? INCLUDED? IF NOT WHAT CPT?

    The Patient was taken to the operating room and placed supine on the operating table. Afer general endotracheal anesthesia was established, the patient was placed in right lateral decubitus positon with axillary roll and well padded down lower extremity on a Wixson table. The left hip and lower extremity were prepped and drapped in a standard fashion using alcohol and cholaprep. The previous incision was re-employed plus extended distally approximately 10-15 cm and carried down the subcutaneous tissue with a knife. Dissection was carried down through the fascial layer and then sub-lateral vastus approach was taken from the distal aspect of the incision. Dissection was carried down to the fracture site. Aquamantys and bipolar were used for cautery. I did a vice grip on the proximal part of the fracture and dissected down the external rotators and capsule and was able to dislocate the hip and remove the head and liner as well. I then worked on getting the stem out. The stem eventually was taken out and the patient had significant calcar of the lesser trochanter. The fracture site was repaired using curette, irrigation and held temporarily with large bone reducing forceps. Eventually cerclage cables were placed from proximal to distal and tightened down and crimped. Anatomic reduction and fixation of the fracture was achieved. More debris was removed from the canal. After all of the debris has been removed from the canal previously along with cement spacer, the fracture was fixed. The reamers were used for the T3 restoration system. I eventually placed a 17mm distal diameter fit, 235 stem length modular stem and then afer trials were undertaken eventually placed a 19mm modular neck zero height with a V40 taper. Trial reduction revealed stable hip with full extension and external rotation as well as with flexion, adduction and internal rotation. The real implants were placed. The wound was copiously irrigated with Bacitracin and Simpulse irrigation. The external rotators and capsule ware repaired using Fiberwire and then Ethibond for the proximal fascial layer. The vastus lateralis were closed with 0-Vicryl running stitch. The wound was copiously irrigated further. The deep fat was closed with 0-Vicryl. The fascial layers were closed over a Jackson-Pratt drain brought out distal to the skin incision. The subcu was closed with 2-0 Vicryl. The skin was closed with staples. The Jackson-Pratt drain was activied. Incision was washed and dried. Sterile dressing applied including Aqua-Seal. The patient was placed on abduction pillow, placed back supine on the operating table. The patient tolerated the procedure well, was extubated and taken to the recovery room.

    SORRY THIS IS LONG JUST WANTED TO MAKE SURE YOU HAD ALL THE INFORMATION..
    THANK YOU FOR YOUR HELP..

  2. #2
    Talking
    Quote Originally Posted by jenkins62 View Post
    NOT SURE IF THIS IS 27236 OR 27138

    PLEASE CLARIFY THE DIFFERENCE..THANK YOU

    DIAGNOSIS:
    LEFT FEMUR PREIPROSTHETIC FRACTURE (996.44)

    PROCEDURE PERFORMED:
    COMPLEX REVISION LEFT BIPOLAR HEMIARTHROPLASTY WITH REVISION INSTRUMENTATION (27236 OR 27138)

    WHAT ABOUT REVISION INSTRUMENTATION?? INCLUDED? IF NOT WHAT CPT?

    The Patient was taken to the operating room and placed supine on the operating table. Afer general endotracheal anesthesia was established, the patient was placed in right lateral decubitus positon with axillary roll and well padded down lower extremity on a Wixson table. The left hip and lower extremity were prepped and drapped in a standard fashion using alcohol and cholaprep. The previous incision was re-employed plus extended distally approximately 10-15 cm and carried down the subcutaneous tissue with a knife. Dissection was carried down through the fascial layer and then sub-lateral vastus approach was taken from the distal aspect of the incision. Dissection was carried down to the fracture site. Aquamantys and bipolar were used for cautery. I did a vice grip on the proximal part of the fracture and dissected down the external rotators and capsule and was able to dislocate the hip and remove the head and liner as well. I then worked on getting the stem out. The stem eventually was taken out and the patient had significant calcar of the lesser trochanter. The fracture site was repaired using curette, irrigation and held temporarily with large bone reducing forceps. Eventually cerclage cables were placed from proximal to distal and tightened down and crimped. Anatomic reduction and fixation of the fracture was achieved. More debris was removed from the canal. After all of the debris has been removed from the canal previously along with cement spacer, the fracture was fixed. The reamers were used for the T3 restoration system. I eventually placed a 17mm distal diameter fit, 235 stem length modular stem and then afer trials were undertaken eventually placed a 19mm modular neck zero height with a V40 taper. Trial reduction revealed stable hip with full extension and external rotation as well as with flexion, adduction and internal rotation. The real implants were placed. The wound was copiously irrigated with Bacitracin and Simpulse irrigation. The external rotators and capsule ware repaired using Fiberwire and then Ethibond for the proximal fascial layer. The vastus lateralis were closed with 0-Vicryl running stitch. The wound was copiously irrigated further. The deep fat was closed with 0-Vicryl. The fascial layers were closed over a Jackson-Pratt drain brought out distal to the skin incision. The subcu was closed with 2-0 Vicryl. The skin was closed with staples. The Jackson-Pratt drain was activied. Incision was washed and dried. Sterile dressing applied including Aqua-Seal. The patient was placed on abduction pillow, placed back supine on the operating table. The patient tolerated the procedure well, was extubated and taken to the recovery room.

    SORRY THIS IS LONG JUST WANTED TO MAKE SURE YOU HAD ALL THE INFORMATION..
    THANK YOU FOR YOUR HELP..
    I vote 27236 - it looks more like an open treatment of a fracture with internal fixation, not a femoral head-hip replacement, which is described by 27138. Hope that helps!

  3. #3
    Default One more thing...
    See the parenthetical note under 27125 (Hemiarthroplasty, hip, partial - eg, femoral stem prosthesis...) It says "For prosthetic replacement following fracture of the hip, use 27236."

  4. Thumbs up
    I agree with 27236, for sure

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