so you think you can code? - foundation for orthopaedic ...4/28/2016 4 • explore gsw 20103 •...
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4/28/2016
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So You Think You Can Code?
Bruce H. Ziran, MD FACS
Director of Orthopaedic Trauma
The Hughston Clinic at
Gwinnett Medical Center
Atlanta, Georgia
Proximal Femur and Shaft
• IM nail intertroch 27245
• IM nail femoral shaft 27506
• ORIF femoral shaft 27507
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Open ankle fx/dxWound is 3cm
Stress test
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• ORIF bimal 27814
• ORIF trimal 27823
• ORIF pilon, both tib/fib 27828
• ORIF syndesmosis 27829
• I&D tibia 11012
• Arthrotomy ankle 27610
• Closure complex wound foot 13131
• Closure complex wound leg 13121
GSWNo PIN functionPoor pulseCT angio negativeGood capillary refill
Bone loss requiring fibular allograftPIN tattered through supinatorUlnar nerve paresis entry by cubital tunnelRadial head and neck involvedBiceps attachment to tuber used as onlayRepair of extensor muscle units 2
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• Explore GSW 20103
• Explore PIN 64708
• Explore Ulnar 64708
• I&D radius 11012
• ORIF prox rad 24665
• ORIF radius 25515
• Repair extensor 25270
• Re‐insert biceps 24342
• Closure wound 13121
• Arthrotomy elbow 24000
Closed. Blister anterior.
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• I&D leg 11042
• I&D leg 11010
• Uniplanar exfix tibia 20690 and foot 20690
• Multiplanar exfix leg 20692
• Closed tx tibia with manipulation27752
• Closed tx pilon with manipulation 27825
Closed. Undisplaced crack distal.
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• IM nail femur 27506
• Open Tx SC femur w/o intra‐artic ext 27511
• Open Tx SC femur w intra‐artic ext 27513
• Open Tx femur distal med or lat condyle 27514
LHD musician. 9 mos after ORIF Gd I open fracture
saw cut of bone endcompression plating
radial nerve identified and protected
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• Removal hardware 20680
• Repair NU humerus 24430
• Explore/release radial nerve 64708
• Osteotomy humerus w or w/o fixation 24400
• Revise scar excision of benign lesion 11406
Grade I open medial
Nerve found in fractureVery brittle bone
Femoral allograft supplementation
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• I&D humerus 11012
• I&D humerus 11044
• ORIF humerus 24515
• Closure 1cm wound 13120
• Repair/release radial nerve 64708
• Complex modifier ‐22 what percent?
Saw cut of NU to create flush bone endsSuspicious looking tissue/bone debrided and saucerizedResorbable beads placedCultures came back positive for S. Epi
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• Repair NU femur 27470
• Remove hardware 20680
• Osteotomy femur w fixation 27450
• Saucerize femur 27360
• Biopsy bone 20245
• Antibiotic depot 11981
• Scar revision 11406
Code?
• 27513 – ORIF supracondylar w/ IC extension
• 27507 – ORIF femoral shaft
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Open ankle fracture
After reduction
• 11 cm wound
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Codes?
• R traumatic ankle arthrotomy I&D 27610
• R open fracture I&D 11012
• R fibula/medial malleolus ORIF 27814
• R traumatic laceration repair multilayered 13132, 13133
• R ankle flexor retinaculum repair 27656
• R PTA exploration 35761
• R PTN exploration 64708
• R ankle syndesmosis operative stabilization 27829
Thank you