Forum - Questions & Answers

Mar 9th, 2015 - jmoon 2 

Orthopedics

Post Op DX: Right Femoral Head Fracture/Dislocation and Posterior Wall Fracture, S/P Open Reduction and Internall Fixation with High Risk of Avascular Necrosis. The planned procedure is Revision of Right Femoral Head Fracture/Dislocation and Internal Fixation.
Per the Op Report: Our attention was turned towards fluoroscopic imaging. On multiple fluoroscopic imaging view, the patient's hip was well-positioned. It would
not dislocate. There was no evidence of subluxation or instability. We
also felt that overall there was no evidence of obvious avascular necrosis.
Therefore, the plan was to partially back out the 3 Steinmann pins while
maintaining stabilization. To that end, an incision was made in line with
the previous scar distally centered at the position of the Steinmann pins
as they exit the femoral shaft area. The incision was carried through skin
with a knife blade and through subcutaneous tissue using Bovie
electrocautery to the level of the IT band. The IT band was incised in a
longitudinal fashion using Bovie electrocautery. At this point, we could
palpate the pins. We could retract the IT band so that the pins were
identified distally. We used a Chandler retractor to further expose the 3
pins at the distal ends, and we used Bovie electrocautery to dissect any
scar tissue surrounding these pins. We then used a heavy needle driver and
reversed the pins out sequentially 1st starting with the most proximal pin,
then the middle pin, and then finally the distal pin. We brought in
fluoroscopic imaging, and we titrated our revision of the pins based on
fluoroscopic imaging. When we felt that the pins were sufficiently across
the physis and maintaining stability but at the same time sufficiently away
from the joint, we then cut the pins at an appropriate level outside of the
lateral cortex for easier removal at a later date. We used a metal cutting
bur to cut the distal end of the pin tips. Final fluoroscopic images were
saved. We were happy with the position of the proximal end of all of our
pins. On fluoroscopic imaging, there was no obviously evidence of
significant avascular necrosis.

My question is what CPT® code to use for the procedure performed? The pins were backed out, but not completely removed. So far I have V54.01 or should I use V54.13 for the PDX? And CPT® 20680 or CPT® 27599 for the procedure.

Thank you.



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