# Need HELP on codes for replacing screws on a previous fusion



## mindyanna (Jun 20, 2011)

Hi,

Can anyone help me with this op report?

DX: nonunion of right tibia

Procedures: application of external fixator to femur and tibia, code 20692, to treat tibial nonunion, and insertion of new screws into the knee fusion rod.

Indications for procedure; This person who had a nonunion of their right tibia treated with a plate and bone grafting previously.  One week ago the plate had become infected and this was removed along with exchange of the locking screws.  Upon visualizing the postoperative radiographs, it was noted that the screws were not through the rod, and the nonunion site was gapped open.  This was secondary to the fact that the plate had been also removed.  Since the nonunion did not have enough stability, we elected to return to the OR to put an external fixator on to stay away from the region of the previous plate application and to revive the distal tibial interlocking screws in the knee fusion rod.

Following the ex fix application (I left that out on purpose) the previous interlocking screws that were at the ankle were then removed, and the drill holes into the intramedullary rod were then filled with Plexur M, and then these were redrilled and rescrewed.  The screws had good purchase and were confirmed on the AP and lateral x-rays to be through the rod. 

Is there a code to represent replacing the screws?  Would it be 27745?

Thanks!


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## chamilton122883 (Jun 23, 2011)

We just had this question come up a couple weeks ago and we determined that we had to go with the unlisted code 27899 for replacement of the screws.  CPT 27745 doesn't quite sound right to me as it is for prophylactic treatment and this does not sound like that was the case. You can of course also bill the removal of implant; deep 20680 for removal of the previous screws.


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