# New to Ortho...27244 or 27245



## Robbin109 (May 24, 2013)

How can you tell if it's a 27244 or 27245?

INDICATIONS FOR SURGERY:
An 88- yr old female fell injuring her right hip. Xray shows unstable intertrochanteric fracture. It was felt she was a candidate for surgical intervention when she was cleared medically. 

OPERATIVE PROCEDURE:
The device chosen was Synthes intertrochanteric nail.

A small incision was made proximal to the greater trochanter. The tip of the trochanter was then identified.

A guidewire was inserted and a 17 mm drill was used to initiate the hole in the proximal femur.

A 10 mm diameter short intertrochanteric nail was chosen. This was then applied to the inserter. It was then inserted under image intensification to the appropriate level.. The attachment to the nail inserted was then applied.  A small incision was made of the blade that was to be inserted. An incision was made laterally. The fascia was incised, and a hemostat was used to open up the soft tissue around this area. It was then placed adjacent to the bone.  The outer drill hole was then placed into the femoral lateral aspect of the femur and into the neck and into the subchondral bone. A lateral drill hole was made for the blade.  Measurements were done. This was determined to be an 85 mm blade. The blade was chosen, the appropriate length, and after drilling the outer cortex the drill was done into the neck and head of the femur. The blade was then placed on the inserter and was malleted in place, checking on the image intensifier, as this was progressed arcos the appropriate depth.

The guidewire was then removed.

The screw was tightened to connect the blade with the nail portion of the implant.
A guide for the distal screw was then applied. A small incision made laterally, and a drill hole made across the implant with bicortical fixation with a 32mm cortical screw. This was again check on image intensifier to make sure that  it was the appropriate position on both AP and lateral projections. 

Thanks!!!!!


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## rbreazile (May 24, 2013)

Since the op report indicates a nail was used, that would be coded as a 27245. If only plates and/or screws used, such as for a hip pinning, then you would use 27244. Intramedullary implants are placed on an instrument and mallet used to place it in the canal and then screws used to fixate the nail in place. Good luck coding! I worked for an Ortho surgeon for 8 years and then he retired. Fun and interesting job, for sure!


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## Robbin109 (May 24, 2013)

Thanks!!!

 I"ve been in Cardio for 7 yrs and learning Ortho now..It's like learning a different language


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