# Fracture Question



## BABS37 (Mar 3, 2013)

I'm working on a fracture and I came up with different codes than another coder so I want to get other opinions on what they think might be appropriate codes to use? Thoughts from anyone? I went with 21453 and 802.29...

P/O DX: Right parasymphyseal and left angle mandibular fracture

Procedure: Open reduction internal fixation of right parasymphyseal and left angle mandibular fracture with mandibulomaxillary fixation. Right mental nerve preserved. 

1. Displaced right parasymphyseal fracture. 
2. Non-displaced left angle mandibular fracture.
3. Repair performed using KLS MArtin 2.0 mm lower mandibular plate and a 2.0 mm upper right parasymphyseal mandibular plate. Repair of left angle fracture using a single four hole 2.0 mm mini plate. 
4. Normal occlusion and normal reduction achieved. 

OP:
Next bilateral infiltration with 1% lidocaine with epinephine was performed. At this point arch bars were then applied using the standard technique. Four point fixation of the upper arch bars was achieved with #26 gauge wire. the lower arch bars were applied in a similar fashion. Interdental fixation was established using fish loops. Normal occlusion was achieved. 

Next attention was turned to the right parasymphyseal fracture. A 15 blade was used to make a mandibular gingival buccal incision. Dissection was carried down through the mucosa and the mental nerve was carefully identified. The peristerum was elevated around teh fracture which ran just in front of the mental foramen. The mental nerve was preserved throughout the entire case. At this point, the reduction forceps were used to maintain normal reduction of the fracture. A lower six hold 2.0 mm KLS Martin mini plate was applied with locking screws and with good fixation. 

Next an upper monocortical four hole 2.0 mm mini plate was applied with normal techniques. Excellent reduction and fixation was achieved. 

Next attention was turned to the left jaw. An incision was made over the angle mandibular region in the retormolar trigone region. The periosteum was elevated. The fracture was identified. A four hole Champy plate was applied using a monocortical technique. Excellent fixation was achieved. At this stage the wounds were closed and the patient was transferred to the Recovery room.


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## BABS37 (Mar 6, 2013)

Anyone have any ideas?


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## cwpierce (Mar 13, 2013)

Op note states and dictates an ORIF procedure. Your choice of 21453 would work had the physician used a closed technique but he made an incision, placed a plate, and closed the wound. I would use 21462 which is the open version of this procedure.

Hope this helps.


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