# Nonunion Tibia IM nail repair



## Rufus186 (Dec 18, 2016)

Has anyone run into this scenario?
 CPT code for Repair of a Nonunion of the Tibia with Intramedullary implant. Should I use CPT code 27759 or 27720? Any thoughts? Thanks


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## thoffert (Jan 10, 2018)

*Nonunion tibia im nail repair*



rufus186 said:


> has anyone run into this scenario?
> Cpt code for repair of a nonunion of the tibia with intramedullary implant. Should i use cpt code 27759 or 27720? Any thoughts? Thanks



*
did you ever get an answer to this thread because i have a similar issue right now. I am stuck between the same codes as well. *


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## Orthocoderpgu (Jan 10, 2018)

*27720*

Code 27759 is for treatment with an IM nail.

code 27720 has this in the description:

Compression technique is one of several techniques that can be used to treat nonunion or malunion of a fracture. This code reports any repair not requiring grafting or synostosis. 

To me it looks like 27720 is the most appropriate.


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## AlanPechacek (Jan 10, 2018)

The codes for *Open Treatment of a Tibial Nonunion* start with *27720* (without bone graft), 27722 (with sliding bone graft), and *27724* (with iliac or other autograft).  Unfortunately, the way CPT is written, 27720 includes Internal Fixation, but is written such that it implies that Compression Fixation Technique (i.e. Compression Plate and Screws) is the only method of fixation used/usable for this repair.  This used to be true years ago, but certainly isn't true today.  IM Nailing is a valid method of fixation/treatment of nonunion, if it can be performed.  The CPT code 27720 needs to be updated to include this fixation method, or be written to include any type of, or "with internal fixation."  Codes 27722 and 27724, as subtypes of 27720, would also include the method of fixation, but differ only in the type of bone graft used and its source.  The code *27759* applies to *Open* *Treatment of (acute/current) Tibial Shaft Fractures*, but not Nonunions of old fractures.

I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.


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## Orthocoderpgu (Jan 11, 2018)

*As always, thanks Dr. Pechacek, M.D. your insigts are so valuable*

As coders we don't always have as much access to our surgeons as we would like. Your comments on the questions posted give us invaluable information and helps coders all over the country understand the pathophysiology, documentation and coding requirements for procedures that we will never see performed.

Thanks for your valuable input from all ortho coders!


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## AlanPechacek (Jan 17, 2018)

Orthocoderpgu said:


> As coders we don't always have as much access to our surgeons as we would like. Your comments on the questions posted give us invaluable information and helps coders all over the country understand the pathophysiology, documentation and coding requirements for procedures that we will never see performed.
> 
> Thanks for your valuable input from all ortho coders!



You are welcome.  I really am trying to help you.  This stuff is not easy.


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