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Thread: Bundling Question 28415 & 28020

  1. #1

    Question Bundling Question 28415 & 28020

    AAPC: Back to School
    One of our surgeons performed both 28415 & 28020 and I'm curious if the 28020 would be bundled with the 28415 even though it was performed in the subtalar joint?
    Anatomically reduced subtalar joint, restored critical angles.

    This is a gentleman with interarticular calcaneus fracture who
    now presents for surgical care with full understanding of the
    risks, benefits and alternatives.

    The patient received preoperative antibiotics. After induction of
    adequate anesthesia, the left lower extremity was prepared in the
    usual sterile fashion after positioning in the lateral position
    with a beanbag. The tourniquet was inflated after exsanguination
    and L-shaped incision for extensile approach to the calcaneus was
    utilized. The lateral wall was decorticated and the articular
    surface was evident within the body of calcaneus and reflected in
    order to allow for mobilization and for reduction to the medial
    wall. The joint was effectively elevated and critical angles of
    Bohler and Gissane were re-created using fluoroscopy. The
    largest articular posterior facet fragments were lagged together
    using a partially threaded screw followed by a neutralization
    plate with an Ace calcaneal plate. The patient was a little bit
    between sizes, so a smaller one was placed and screws were placed
    divergently. The wound was then copiously irrigated and closed
    in layers. All bone material that was removed during the course
    of surgery was placed into the central void as well as the
    lateral wall was closed on top of the void. The patient's wound
    was copiously irrigated and closed in layers followed by bulky
    soft dressing and stirrup splint.

    The patient tolerated the procedure well. There were no
    intraoperative complications.

    Of note, during the exploration of the subtalar joint, articular
    and bone fragments were noted to be loose bodies and were

    All needle and sponge counts were correct.

    To the Recovery Room in stable condition.

    Ace calcaneal plate with assorted screws from small fragment set.
    ************************************************** ***

    Thank you, I would appreciate anyone's opinion.

  2. #2
    Join Date
    Apr 2007


    my two cents: yes it bundles.

    why I think so: sounds as if he accessed the calcaneous through the subtalar joint, while he was there he removed the loose bodies.

    Hope this helps

  3. #3


    thank you mbort!!

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