# TFN NAILING OF FEMUR FRACTURE



## cwilson3333 (May 16, 2020)

Question on coding for this procedure

Patient Diagnosis:  Intertrochanteric Fracture of Left Hip

Procedure:  Long TFN fixation of intertrochanteric fracture
Complications:  An intraoperative extension of femoral fracture
                          [Short 11 mm nail on impacting, caused crack in lateral cortex; Removed short nail, and reamed up to 11.5 mm, and put in long TFN nail.  Distal screw placed in other fracture, freehand.]

Am I billing only a CPT 27245 and modifying with a 22 for the complication?  Or do I need to also  code separately for the complication?

Anxious for some other ortho coder responses.
Thank you


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## twizzle (May 16, 2020)

You would not code for the complication because it happened during the procedure and effectively did not alter the course or outcome of the surgery. All that happened was that a long nail was placed instead of a short nail.

You do not use modifier 22 for a routine complication. Nowhere does the provider document any significant increase in difficulty or time over and above the usual time taken to perform 27245. Payers request documentation before considering any claims with a 22 modifier and it needs to clearly state why a procedure was much more complicated/time-consuming than usual and how much more time was needed by the provider to complete  the surgery than they would normally spend (documenting it took 45 minutes longer than usual or 50% longer than usual are examples that will suffice along with the reasons why).


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## Orthocoderpgu (May 18, 2020)

Second reason why you cannot bill -22 for this. The fracture extension occurred during surgery. Even if this took substantially longer, you still would not be able to bill for this since it was provider caused. Don't misunderstand what I am saying. Not saying that the provider caused this intentionally or accidentally. These things just happen. But since the fracture extension occurred during surgery you cannot bill -22.


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## cwilson3333 (May 18, 2020)

Thank you one and all !!!!


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