# coding ex fix removal



## mksmith713 (May 7, 2009)

I'm a newly certified CPC-A.
I'm not working as a coder but am trying to gain knowledge and insight.
I'm inquiring as to what to expect when coding an OP note for a physician.
Will I have to code ICD-9 for a condition and/or just code(s) the procedure?
What about multiple procedures, i.e, bi lateral external fixator removals with rod insertion?

I'll give an example and hope someone will chime in.

The procedure: removal of bilateral foot and tibia multiplanar external fixators after successful correction of  equinus deformities.
Prophylactic rush rod insertion bilateral tibias with application of short leg casts.


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## mbort (May 8, 2009)

typically..when coding from operative reports, you will code both the procedure and the diagnosis codes.


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## mksmith713 (May 11, 2009)

Yeah, I figured that.
The main problem I have with the OP notes is that the docs aren't giving me a clear cut diagnosis.
I might get something like," After a successful lengthening of the femur, tibia and fibula, it was decided to removal the femur and lower leg external fixation devices"......

What the hell is that?..........LOL

Lengthening for what?

I can't assume.........

This is going to be a tough learning experience.....


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## mitchellde (May 11, 2009)

Luckily you will not need to know why they lengthened the bone, for some reason they did.  your note tells you that, " after successful lenghtening of the femur, tibia, and fibula...."  That was the bone they lengthened, maybe with a bone graft and they had an external fixator in place while the bone was healing.  Now it is time to rmove the fixator  this was an external by your description so visulize somethin afixed to the leg that you can see without an incision.  A cast is one example of an external fixation, this was probably a frame of sometype.  Now the dx is going to be a V code for fitting and adjustment of Orthopedic device look in the range of V52 to V54, then for procedure it will depend on the body of the op note but look under the header of repair, revision.  if you want help with the actual codes you will need to supply the substance of the procedure note.  I hope this has been of some assistance.
Debra Mitchell, MSPH, CPC-H


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## mbort (May 11, 2009)

hmmmmm I've never heard of a cast being considered "external Fixation"???  Where did you get this information?  Can you post the documentation to support casting as external fixation?

Thanks
Mary, CPC, COSC


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## mitchellde (May 11, 2009)

Anything that holds the fracture in correct alignment is a fixation and a cast is external, Most people do not use the term fixation for a cast but truely by definition it is a type of fixation, I am not sure what else you need.  I talk with my hands alot so putting it in written words is a little more difficult.  I was not meaning in terms of a code for external fixation necessarily but as an example of a type of external fixation.


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## mbort (May 13, 2009)

I have never heard this..therefore had to research it 


In my CPT 2009 Professional Edition, page 75, top of right column:

*External fixation is the usage of skeletal pins plus an attaching mechanism/device used for temporary or definitive treatment of acute or chronic bony deformity. *

Therefore based on that...casts are not considered external fixation.

Hope this helps
Mary, CPC, COSC


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## mitchellde (May 13, 2009)

Mary,
I know what the book says with respect to that section of codes however the definition of external fixation from the medical dictionary is
external fixation
n.
The fixation of a fractured bone by a splint or plastic dressing.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.
Let us just leave it at that, we are both correct, anything that holds the bone in correct alighnment external to the body is external fixation.
Thanks
Debra


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## mksmith713 (Sep 14, 2009)

A cast in not consider and external fixation device.
An external fixation device uses pins and/or wires though the bone above and below a fracture site with an external frame attached to said pins and/or wires to hold a bone in place during the healing or, in this case, lengthening process.


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