# CPT help needed for Nonunion/Malunion fx



## dhuttie (Aug 26, 2013)

Patient had a comminuted humeral shaft fx - 6 months later it has not healed. Doctor, in the opeartive report heading calls it a "nonunion" - but also later in the report under "findings" says there "malunion of butterfly fragment and proximal fragment". I gathered the bulk of the fx is "nonunion".
He states "Attempt at reduction was done, it did not appear to fit anatomically or in a manner conducive with open reduction and internal fixation. Therefore, decision was made to utilize a bur to create step osteotomies and the proximal and distal portions to allow for good bony apposition." He creates the step osteotomy down to good bleeding bone then reduces the osteotomy sites and clamps them in place. He then places a screw across the osteotomy site - then 8 hole plate was positioned. Bicortical, cortical and locking screew used to fix the plate.

Should I use 24515 Open treatment of humeral shaft fracture with plate/screws, with or without cerclage  and add -22 modifier to since the added work of the osteotomy?

Or should we look at 24400 Osteotomy, humerus, with or without internal fixation? 

I'm not understanding why the 24400 pays less - seems more work involved.

Any guidance would be greatly appreciated.


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## krachow1 (Aug 26, 2013)

*Cpc*

Neither, use CPT 24430: "repair of nonunion or malunion, humerus, without graft".  The injury is no longer an acute fracture so billing for fracture repair would not be appropriate.  The above CPT is for the repair of the nonunion regardless of the method so the osteotomy would not be separately billable.  I would use ICD-9cm code 733.82 (nonunion) and 905.2 (Late effect of fracture of upper extremities)

Hope that helps!


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## babsdean (Aug 26, 2013)

I agree the Osteotomy is the correct code even though it pays less.


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## dhuttie (Aug 27, 2013)

krachow1 said:


> Neither, use CPT 24430: "repair of nonunion or malunion, humerus, without graft".  The injury is no longer an acute fracture so billing for fracture repair would not be appropriate.  The above CPT is for the repair of the nonunion regardless of the method so the osteotomy would not be separately billable.  I would use ICD-9cm code 733.82 (nonunion) and 905.2 (Late effect of fracture of upper extremities)
> 
> Hope that helps!


I completely overlooked 24430 - I just kept seeing "elbow" jumping out at me and just bypassed it alltogether! That is EXACTLY what I was looking for.  Thank you for pointing out the obvious. And I am in complete agreement that it is no longer an "acute" injury that is being treated. 
Thank you again.


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