# dx for nonunion ulnar shortening osteotomy



## kdsampson (Nov 27, 2012)

Need a 2nd opinion. My dr. did a revision ulnar shortening osteotomy, dx nonunion ulnar shortening osteotomy. The original osteotomy procedure was for ulnar carpal impaction, not a fracture. 

Am I correct in billing 25400 for the procedure, and would I use 733.82 even though this wasn't a fracture? Op report as follows:

The non-union was identified.  It was curetted out to give us some relatively fresh ends. We then moved forward to place the Acumed unlar shortening osteotomy.  We placed the plate on distally and drilled and filled the most distal screw with a locking screw under C-arm visualization. We then drilled the proximal most oblong hole to achieve compression and measured this to be a 16 buth then placed the compression knob in that hole for compression later. 

We then drilled the third most distal hole and filled it with the appropriate length locking screw and then placed the locking guide into the second hole to allow for compression.  Prior to compression, a saw blade was then used to saw off the distal and proximal ends of the ulna making them parallel with each other. Compression was then performed across the ulna and it gave us good compression and after appropriate compression was achieved, we released the compression and filled the void with allograft bone and demineralized bone matrix and then compressed again locking it into place and drilling the third most proximal hole with the appropriate length non-locking screw. We then drilled the osteotomy screw of the appropriate length while holding it in place.  We then removed teh compression device, drilled the second most distal hole with the appropriate length locking screw and finished this with the most proximal screw filled with the appropriate length locking screw. We then removed the compression and filled that hole  with the appropriate length non-locking screw. The heterotopic bone from the nonunion had filled the space between the ulna and the radius giving us clear popping between the ulna and radius.  

Thanks!


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## PLAIDMAN (Nov 27, 2012)

I get these but with non union of a fusion....

I use a complication code

996.49
998.9


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## kdsampson (Nov 27, 2012)

Thank you for your input


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