Alfaro33
Networker
Payer is denying 27236, I did not assign 27125 due to this being a fracture. What am I missing? Any insight would be appreciated?
Postoperative Diagnosis
1. Closed displaced fracture of right femoral neck
Operation
1. Open treatment of right femoral fracture, proximal end, neck, prosthetic replacement
Findings
1. Right displaced femoral neck fracture
Implants
1. Zimmer Avenir Femoral Stem Cementless Collared Standard Offset 12/14 Taper Size 5
2. Zimmer Biolex head 28/+3.5
3. Zimmer Bipolar CoCr Shell 50mm OD/28mm ID
Indication
The patient was indicated for right hip hemiarthroplasty for their femoral neck fracture.
Attention turned to performing a hip hemiarthroplasty for the right femoral neck fracture. The direct anterior Hueter approach was was utilized to access the right hip joint. Incision was made roughly 3 cm lateral and distal to the anterior superior iliac spine. The tensor muscle belly was identified and the fascia was split in line with the femur. The Smith-Petersen interval was entered. Retractors were placed around the femoral neck. The lateral femoral circumflex vessels were identified and coagulated. An anterior capsulectomy was performed. The femoral neck fracture was identified. Femoral neck cut then made beginning at the saddle and proceeding infero-medially to approximately half a fingerbreadth above the lesser trochanter. The intervening bone segment was removed. The femoral head was removed with a corkscrew on power. Attention was then turned to the femur. The operative leg was abducted and externally rotated. The superior lateral capsule was resected off of the proximal femur which allowed the femur to be elevated out of the wound. Box osteotome and femoral canal finder were used to enter the femoral canal and establish version. We began broaching at size 0 and broached up to size 5. This was stable to axial and rotational forces. With the final broach fully seated, calcar reaming performed to the level of the broach face with a calcar planer. We then began trialing. With a size 5 femoral broach, standard offset neck, 28+3.5mm femoral head, and 50mm acetabular shell leg lengths were restored and the hip was perfectly stable on the table. It could not be dislocated with any provocative maneuvers. Trials were removed. The final implants were placed. The calcar was checked to ensure no fractures. The final bipolar head was impacted onto the dry trunnion. The hip was finally reduced. Leg lengths and stability were checked again for a final time and deemed appropriate. Final fluoroscopy confirmed concentrically reduced hip, no identifiable fractures, and appropriate implant position.
Postoperative Diagnosis
1. Closed displaced fracture of right femoral neck
Operation
1. Open treatment of right femoral fracture, proximal end, neck, prosthetic replacement
Findings
1. Right displaced femoral neck fracture
Implants
1. Zimmer Avenir Femoral Stem Cementless Collared Standard Offset 12/14 Taper Size 5
2. Zimmer Biolex head 28/+3.5
3. Zimmer Bipolar CoCr Shell 50mm OD/28mm ID
Indication
The patient was indicated for right hip hemiarthroplasty for their femoral neck fracture.
Attention turned to performing a hip hemiarthroplasty for the right femoral neck fracture. The direct anterior Hueter approach was was utilized to access the right hip joint. Incision was made roughly 3 cm lateral and distal to the anterior superior iliac spine. The tensor muscle belly was identified and the fascia was split in line with the femur. The Smith-Petersen interval was entered. Retractors were placed around the femoral neck. The lateral femoral circumflex vessels were identified and coagulated. An anterior capsulectomy was performed. The femoral neck fracture was identified. Femoral neck cut then made beginning at the saddle and proceeding infero-medially to approximately half a fingerbreadth above the lesser trochanter. The intervening bone segment was removed. The femoral head was removed with a corkscrew on power. Attention was then turned to the femur. The operative leg was abducted and externally rotated. The superior lateral capsule was resected off of the proximal femur which allowed the femur to be elevated out of the wound. Box osteotome and femoral canal finder were used to enter the femoral canal and establish version. We began broaching at size 0 and broached up to size 5. This was stable to axial and rotational forces. With the final broach fully seated, calcar reaming performed to the level of the broach face with a calcar planer. We then began trialing. With a size 5 femoral broach, standard offset neck, 28+3.5mm femoral head, and 50mm acetabular shell leg lengths were restored and the hip was perfectly stable on the table. It could not be dislocated with any provocative maneuvers. Trials were removed. The final implants were placed. The calcar was checked to ensure no fractures. The final bipolar head was impacted onto the dry trunnion. The hip was finally reduced. Leg lengths and stability were checked again for a final time and deemed appropriate. Final fluoroscopy confirmed concentrically reduced hip, no identifiable fractures, and appropriate implant position.