# Pathologic Fracture



## lmcreynolds@aoamail.net (Jul 27, 2016)

Hello,

My doctor operated on a patient who has a history of colon and breast cancer who presents with a pathologic midshaft fracture of her femur.  She did have an intertrochanteric fracture of the same femur in 2013 and at that time underwent stabilization with a long trochanteric fixation nail without distal interlocking screws.  She now presents with this fracture being well traversed by the intramedullary nail but having rotation instability due to this fracture and the lack of the interlocking screws distally.  His operative procedure description is "Stabilization of the right pathologic femur shaft fracture with interlocking of previously placed intramedullary device"[/COLOR].  And in the body of the op note it states "Using a perfect circle technique distally through percutaneous stab incisions two statically placed interlocking screws were placed in the distal aspect of the nail adequately interlocking the nail within the femur".  Basically, the nail was already there in the femur and he added screws to it to stabilize it.  

I wanted to double check the CPT code.  27495 was what we came up with.  

Thanks for your help.

Lorie


----------



## talitha82 (Jul 27, 2016)

My Encoder Pro states the following: 

Prophylactic treatment is performed to prevent injury or fracture of diseased bone. Therefore, 27495 should not be reported when a fracture is being treated. For treatment of a fracture, see 27500-27514. Removal of a superficial implant (e.g., buried wire, pin, or rod) is not reported separately. For radical resection of a tumor, bone, femur or knee, see 27365. For radical resection of a tumor (e.g., malignant neoplasm), soft tissue of thigh or knee area, see 27329. For partial excision (craterization, saucerization, or diaphysectomy) of bone (e.g., for osteomyelitis), femur, proximal tibia and/or fibula, see 27360.

I don't know how helpful this is, but I'm thinking you can't use 27495...


----------



## lmcreynolds@aoamail.net (Jul 28, 2016)

Yes, that helps a lot.  Thank you so much!!


----------



## AlanPechacek (Aug 7, 2016)

As presented in your query, all your surgeon did was to make use of the existing, previously implanted fixation (Long Proximally Locked Intramedullary Femoral Nail Fixation Device) in treating the current/new pathologic femoral shaft fracture by putting in the two distal locking screws, percutaneously with Fluoroscopic guidance.  He did not open or expose the fracture, i.e. "open treatment," but rendered "closed treatment" by percutaneous screw fixation through the existing nail.  There is no code for this procedure, so you would need to use 27599, Unlisted Procedure, femur or knee.  The closest "match" for this would probably be 27509 for percutaneous femur fracture, distal end.

Hopefully this helps some.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


----------

