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Surgery HELP Please

  1. Default Surgery HELP Please
    Medical Coding Books
    CPT codes - 27580, 27514, 11982

    Above are the CPT codesI used to bill this surgery. The insurance is denying including CPT 27580 and 27514. Can someone help me and look at the report and tell me if or what I might being doing wrong and why the insrance might be including these procedures. Thank you.

    1. Irrigation and debridement of the knee.
    2. Removal of antibiotic spacer.
    3. Knee fusion.
    4. Open reduction and internal fixation of medial condyle
    fracture and nonunion.

    Her previous midline
    incision was utilized. We went medially around the skin graft.
    Small flaps were elevated off the extensor mechanism. The
    extensor mechanism was opened through a medial parapatellar
    approach. There was a bloody fluid present in the knee. The
    spacer block was freely mobile in there. The medial femoral
    condyle was broken off with a nonunion. Ultimately the spacer
    block was removed. Cultures were taken. The Gram stain was
    called back as no organisms. A frozen section was taken as well
    which was called back as without evidence of acute inflammation.
    This was all felt to be at least response to the adequate
    treatment of her infection. We then proceeded with the knee
    fusion. The bony surfaces were completely curetted off. The
    canals were curetted free as well. We assessed our bony defects.
    The nonunion was taken down and the bony edges of the medial
    femoral condyle freshened up as well. The tibial canal was
    curetted out and all the cement was removed from here. We packed
    the tibial canal to prevent debris from entering and turned our
    attention to the femur. The femur was reamed to accept the 18 mm
    Wichita nail stem. This was impacted into place. Once we
    confirmed that it would fit, we assessed our bony defects. We
    placed an intramedullary guide and cut the lateral femoral
    condyle which was impacted 0 degrees to give us a reasonable bony
    surface. We cut the medial femoral condyle which was loose as
    well in a way that would allow us to reduce it into the fusion
    site at the end. Happy with this, the rod was placed up the
    femur and tapped into place. C-arm fluoroscopy was utilized to
    confirm good position. The proximal Prostalac screws were placed
    under standard technique with two 30 mm Prostalacs. This was
    nice and rigid. It should be mentioned that rotation was marked
    on both the tibia and the femur prior to starting. We assessed
    the position of the leg and the position of the other leg to
    provide a little bit of external rotation. Happy with the
    fixation of the femur, we turned our attention to the tibia. A
    freshening cut was made on the tibial surface with just a couple
    degrees of slope. We had reasonable bone here as well and a nice
    flush surface. The canal was reamed to accept a 12 mm tibial
    rod. This was actually quite tight distally. C-arm fluoroscopy
    was utilized to confirm good position and straight alignment.
    Once we were happy with this, the final rod was assembled and
    impacted into place. We cut out the square of the tibia and
    turned this into bone graft. The proximal Prostalac screws were
    placed here as well. The distal Prostalac screws were not placed
    as this was very tightly engaged in the cortex. Happy with this,
    we assessed our rotation and happy with this, engaged the nail.
    We removed the proximal jig. The compression screw was placed
    on the rod and we engaged them both together and compressed. We
    actually had quite good contact laterally. Pretty good flush
    surfaces that really compressed quite nicely. We were able to
    shape the medial femoral condyle piece and reduced this in as
    well. We held this in place and placed a single 65 cancellous
    screw diagonally across the piece and down into the tibia which
    actually compressed it into the union site quite nicely. Overall
    rotation and alignment of the leg was checked with C-arm
    fluoroscopy which was confirmed to be good.

  2. #2
    Piedmont Area Coders, VA
    Hi Sara--
    My thought, after a quick read, is that you are going to LOSE the 27514 into the more extensive 27580. It reads like the revison of the MFC nonunion was PART of the fusion.
    I would say drop the 27514, and bill out the 27580 with your 11982.
    Did you submit the orig charges with a 59 on the 27514?

  3. Default
    Hi. Thanks so much for your response and help. Yes a 59 was appended to CPT 27514. They requested the notes and then denied it.

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