# 27540 vs 27535



## kdsampson (Mar 20, 2013)

I want to get another coder's opinion in case I'm looking at this incorrectly.  I'm saying 27540 is the correct cpt code, the ASC where surgery was performed says 27535.  Which is more appropriate?


POST-OPERATIVE DIAGNOSIS: Displaced tibial tubercle fracture left proximal tibia

OPERATIVE PROCEDURE: Open reduction internal fixation tibial tubercle fracture left proximal tibia 

INDICATIONS AND FINDINGS: The patient is a 15 year old male who was playing soccer. He landed hard on his left leg and noted immediate pain and a popping sensation. He was evaluated at the emergency room where an avulsion fracture through the tibial tubercle was noted. A CT scan of his knee was obtained revealing continuation of fracture into the articular surface of the proximal tibia. There was noted to be widening and anterior displacement of the tibial tubercle. The patient was taken to surgery where an open reduction internal fixation was performed utilizing the Synthes system with two 4.5 mm cannulated screws to secure the tibial tubercle.  

PROCEDURE IN DETAIL: The patient was taken to the operating room, placed supine upon the operating table and a general inhalation anesthetic was administered.  A well-padded pneumatic tourniquet was placed about the upper aspect of the left thigh. A ChloraPrep and sterile drape of the left lower extremity was performed. The left leg was elevated, exsanguinated and the tourniquet was inflated to 200 mmHg pressure. A 5.0 cm long longitudinal incision was made just medial to the tibial tubercle. The incision was deepened. There was periosteal avulsion off the proximal medial tibial and the fracture was identified. The fracture hematoma was irrigated and curetted. The fracture was then reduced. Under fluoroscopic guidance, two Synthes guide pins were then placed from an anterior to posterior direction across the avulsed tibial tubercle. The proximal cortex was overdrilled and a 54 mm terminally threaded 4.5 mm cannulated screw was placed superiorly. The procedure was repeated with a 46 mm cannulated Synthes screw placed inferiorly. The screw placement and fracture reduction was verified in AP and lateral planes and found to be stable. 
The periosteal flap which was significantly thickened was then reattached on the medial aspect of the fracture with multiple interrupted figure-of-eight sutures of #0 Vicryl. The subcutaneous tissues were closed with inverted #2-0 Vicryl suture and the skin was closed with a running #4-0 Nylon suture. The skin and subcutaneous tissues were infiltrated with Marcaine 0.50% solution without Epinephrine. An Adaptic Neosporin bulky dressing was placed about the knee. The knee was immobilized with a long leg fiberglass splint from the medial and lateral aspect of the leg and the inner supramalleolar area. The patient was awakened and transported to postop recovery with anesthesia, personnel present in stable condition.


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## dclark7 (Mar 20, 2013)

Check with you insurance carrier (find out if they use CMS guidelines), but according to CMS 27540 is an inpatient procedure.


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## kdsampson (Mar 22, 2013)

I'm not familiar enough with these procedures to know, but if it's an orif of the tibial tubercle and 27540 states orif tuberosity fractures and 27535 states orif tibial plateau would it not be correct to bill 27540 since it's specific to the tibial tubercle or since they both encompass the proximal tibia is it ok to change it to 27535?  

This is where I start doubting myself in coding.  Any help or thoughts are greatly appreciated.


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