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Help physicians and patients understand exactly what it all means. One of the most asked questions coders get from patients at an orthopedic practice is: “Why is there a surgical code on my bill for an office visit?” It’s a valid question coming from a patient who was seen in the clinic, treated for a […]
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Thanks,
Teri
I am having a bit of difficulty in coding the wound from an open fracture and any help would be great. Patient fell and had an open fracture of the ankle which the orthopod took to surgery and performed an open repair with plates. Before the main fracture open fracture repair, the orthopod took the patient to the OR to irrigate, debride, and perform a closed reduction of the open fracture. The provider planned on going back to the OR the next day. The second surgery by the same doctor, the surgeon created a lateral incision to plate the fracture and he also made an incision over the open wound site (or extended it, hard to tell). Both procedures have a global period and the orthopod is seeing the patient for post op care for the fracture but he also referred the patient to our wound care clinic to be treated for the open wound (where the bone went through the skin) and this wound was left open secondary to healing. The wound from the bone is not infected nor is there any tissue death and our midlevel at the wound care clinic is treating/providng care for the wound (not the surgical incision, but where the bone went through the skin). I do not believe the wound care doctor can bill for this as it is related to the open fracture and there is no complications at this time or at the time of referral. In addition, the patient is still having post op visits for the fracture by the surgeon for the surgical incisions. The wound clinic and the orthopedic doctors are of the same billing group, but I am only coding for the wound care visits at this time. Can the midlevel charge for office visits for this patient or is that considered part of the global period for the original open fracture? Can anyone please help?
Thanks,
L
"We then proceeded to mark the landmarks laterally and made a linear incision slightly lateral to the coracoid and extending to the deltoid attachment distally. Once through the skin and cutaneous tissues were dissected sharply down to the deltopectoral interval. We then identified the cephalic vein and attempted to move this medially. Bleeding did occur and this did have to be tied off with 0 silk sutures. Once the deltopectoral interval was entered we identified the lateral edge of the conjoined tendon and incised the clavipectoral fascia proximally and distally. We were then able to place a self retaining retractor into this interval for better visualization. We easily identified the shaft fracture as this was sitting directly behind the conjoined tendon. Once this plane was developed we identified that the biceps tendon and proceeded to perform a bicipital tenodesis to the intact pectoralis major insertion. We resected the remainder of the tendon and then placed traction sutures through the subscapularis muscle and around the lesser tuberosity fragment as well as posteriorly around the greater tuberosity fragment. We incised the upper 25% of the pectoralis major insertion and then receded to clean soft tissue out of the fracture site. Once this was cleaned we then manually reduce to fracture and verified this on AP fluoroscopy. We then were able to shift the humeral head in the position and with distal traction were able to achieve reasonable reduction we then selected a short Zimmer high proximal humerus plate f and placed this anterior laterally over the humerus just lateral to the pectoralis major insertion and just posterior to the bicipital groove. Once this was complete and held into position with threaded K wires AP and lateral images were obtained to ensure good reduction. Once this was confirmed, we proceeded to place a single standard 3 5 cortical screw using AO technicque distally in the oblong hole. Once this was adhered to the distal shaft, the proximalmost locking screw was then placed using standard AO technique. We then removed the K wires confirmed reduction on AP and scapular Y and then proceeded to place an additional 4 locking screws proximally. We then placed an additional 2 screws distally the second from the most distal hole was placed locking and the distalmost hole was placed nonlocking. Once this was complete final AP and lateral images were obtained. We copiously irrigated the incision site and reapproximated the skin with 2-0 Vicryl and staples."
Thanks
I was going to use CPT code 23472. However now I am wondering should I be using CPT code 23616?
thanks
The doctor dictated a closed reduction and percutaneous fixation of metacarpal dislocation (26676) and closed reduction and percutaneous fixation of MCP fracture of right small finger (26608). Dx is "baby Bennett’s fracture dislocation right small finger metacarpal" S62.316A and S63.064A.
And it’s not clear in the body of the OP report if those were two separate reductions. It says "A closed reduction of the fracture dislocation was performed by pulling traction on the ring and small fingers and pushing from dorsal to volar at the CMC joint. Fracture reduction was checked in PA and lateral views with mini C arm fluoroscopic imaging. The X-ray images demonstrated excellent reduction of the fracture dislocation of the CMC joint of the right small finger. Next, 3 percutaneously placed K-wires were placed across the fracture from a ulnar to radial direction."
Any suggestions? Thank you! 