My provider performed a ORIF metacarpal malunion with osteotomy. My code choices are 26546 or 26565. The issue I’m having is I’m not sure if I can use 26546. The description for this code is for a nonunion and my procedure was performed on a malunion..

Thanks in advance.

I then examined the middle finger metacarpal. Traction and manipulation efforts would not move the dislocation at all. I therefore elected to proceed with open reduction internal fixation. A 4 cm longitudinal incision was then made in the region overlying the metacarpal fracture. Skin was incised sharply. Blunt dissection was then taken. The extensor tendons were protected. The periosteum overlying the fracture was sharply elevated. Debris was cleared from the fracture site. After clearing fibrous tissue it became clear that there was bone bridging the dislocated shaft and the other fracture fragments including the large articular segment which was dislocated. This was therefore a malunion. I therefore needed to proceed with an osteotomy. Using an osteotome, I carefully attempted to follow the original fracture lines and osteotomed through the newly formed bone to recreate the original fracture fragments. A roungeur was also used to clear debris.

The wound was irrigated. The shaft was first reduced to the proximal ulnar fragment. This fracture was reduced with traction manipulation and pointed reduction clamp. I then placed a pin through the index metacarpal into the middle finger metacarpal while maintaining traction and reduction of the middle finger metacarpal. I then fixed the shaft to the proximal ulnar piece again. While maintaining this reduction a pin was placed across it. I was initially hoping to place a lag screw across the fragment but there was not enough sufficient bone on the exposed side and I feared fracturing the fragment. However, there appeared to be adequate fixation with the pins. I then fixed the ulnar articular surface piece to the shaft with two additional pins.