# closed reduction, percutaneous screw fixation of lateral tibial plateau fracture



## laurabee (Aug 4, 2008)

I'm having trouble with this CPT code. Here's the op note:

DX: Split compression fracture of the right tibial plateau laterally
OPERATION: Closed reduction, percutaneous screw fixation of lateral tibial plateau fracture

PROCEDURE IN DETAIL: The patient was placed in the supine position with establishment of general endotracheal anesthesia. The right lower extremity was prepped and draped in a sterile fashion. The C-arm was used to visualize the fracture and the tenaculum clamp was used to reduce the fracture. Good position verfified on the AP and lateral planes. Two of the 7.3 guidewires were then placed across the fracture site parallel to the joint surface in a buttress type fashion, measured to a 65 and 70, checked on the AP and lateral views, showed good position, and they were then sequentially placed more anterior. A 65 placed with a washer synched down with excellent fixation noted. Good position was then verified in the AP lateral planes. There was significant improvement of the fracture alignment and good position on the screws. They were both just protruding through the medial cortex as they needed to be and were palpable but not prominent. 

I'm confused on percutaneous fixation. Some fractured have their own per-Q fixation CPT codes and some don't? This may be a dumb question but I'm coding for my company before taking the CPC and it's being checked over by a certified coder. I've looked everywhere trying to find info on this. Is it 27530 or 27532 with 20690? Ack!


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## mbort (Aug 4, 2008)

He reduced the fracture therefore that eliminates the 27530.

The fixation is not external--its internal, so that eliminates the 20690 w/27532

Even though he does not state an actual "incision", by piercing the skin and entering the joint this "can" now be considered an open procedure. 

Since he only mentions the lateral tibial plateau, this is unicondylar, I would recommend 27535, (probably with a 52 modifier)

(and the -26 component of the fluoro if not formally read by a radiologist)


Hope this helps
Mary


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## laurabee (Aug 6, 2008)

thank you mary!


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## FTessaBartels (Aug 6, 2008)

*I'm not sure I agree w/ "open"*

Mary,
This isn't my area of expertise, but ... 

I'm not sure I agree that a PerQ is "open" just because they have pierced the skin and entered the joint.
If it *were* to be considered open, then why bother to have so many specific PerQ fixation codes?  CPT would just state -"see open fixation."

I think it might be more appropriate to use the dreaded "unlisted procedure."

F Tessa Bartels, CPC


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## mbort (Aug 6, 2008)

I understand where you are coming from F Tessa. 

Unfortunately this is one orthopedic area that has not yet seen a Perq pinning code.  The 27535 best describes the procedure that was performed with the exception that there was no official "incision" documented in the above scenario.  Although it is not clearly documented in this particular scenario, "usually" the surgeon makes a small incision for the "perq pinning" and they dont really just stab it through the skin (at least my docs dont).  That is why I also suggested the 52 modifier on this particular case.

If one were uncomfortable with the 27535, they could certainly use the unlisted code and cross-reference the 27535 on their claim.


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