# Hip fracture confusion



## Lisa Bledsoe (Jul 15, 2010)

One of my docs wants to code 27230 for a femoral neck fracture and I want to code 27236 and here's why: (multiple attempts at pinning the fracture with fluoro were unsuccessful)..."it did not appear that we were moving the fracture.  It appeared to be impacted.  We decided not to proceed with too aggressive rehab for fear of damaging the blood supply.  At this point...using a 15 blade scalpel, a 4-cm incision was made over the greater trochanteric area.  This was carried down to subcutaneous tissue.  Several bleeding vessels were identified and coagulated.  The deep fascia was then divided in line with the incision.  The guide for the 7.3 cannulated screw set was placed on the trochanteric region and through the femoral neck into the femoral head.  Its position was checked on AP and lateral radiographs.  Several small adjustments were needed but once we had this in place, another pin was placed anterior inferior to this pin and another one was placed posterior superior to this to get 3 pins in different planes of fixation.  After ascertaining they were in good position, the near cortex was drilled with the cannulated drill and 7.3 short threaded cannulated screws were placed up over the drill guides until the screws were in good position..."  (whew)
So, I see this as open.  He says that it is not considered open unless they actually see the fracture site.  I have never heard this.  I am going to be taking my COSC in October, so I want to make sure I know what I'm doing.  

So is this 27236 or 27230?  Well, he says 27230 but if it's not 27236 wouldn't it then be 27232??????

PLEASE HELP


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## CatheB (Jul 15, 2010)

I agree with you on the 27236 from what you have here. I have the 3M software and even if you put closed reduction with internal fixation it still gives the 27236, unless it was percutaneous fixation. Good luck on your exam! I am taking mine in August.


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## Lisa Bledsoe (Jul 15, 2010)

CatheB said:


> I agree with you on the 27236 from what you have here. I have the 3M software and even if you put closed reduction with internal fixation it still gives the 27236, unless it was percutaneous fixation. Good luck on your exam! I am taking mine in August.



Good luck to you too!!  
Definately NOT percutaneous...he made an incision and that to me makes it open...


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## malery (Jul 16, 2010)

Good Morning,
Ingenix coding companion for Orthopaedics-Lower manual appears to leaning towards Percutaneous 27235

It states for Percutaneous 27235: Quote:
"Treatment that is neither open or closed. In this procedure, the injury site is not directly visualized. Insted, fixation devices (pins,screws) are placed to stabilize the dislocation using x-ray guidance." 

But in procedure 27236 it states: Quote
"The physician directly exposes the femoral fracture for treatment." also stating that "a 15cm incision is made over the lateral hip."

I would have to disagree that its a 27230 or 27232 because of the amount of incision and fixation being used but I do agree that its not really 27236 because the fracture site was not exposed but rather by x-ray guidance. The CPT book also indicates that 27236 is (with fracture exposure.)

Wow! Its like he's inbetween these two codes.

Good luck with your test. It was harder than I expected. 

Melodie Alery, COSC


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## Lisa Bledsoe (Jul 19, 2010)

Melodie - that is very helpful information.  I think I will bill 27232-22.  

I will definately be getting the coding companion for my exam!!

Thank you


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## sagni23 (Jan 22, 2014)

By the way, why are you using modifier 22 here and do we need to use 77002 if it was done under fluoroscopic control.


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