# Femur surgery



## amartinez1 (Oct 15, 2010)

I have a patient that was seen in our physician's office and then he had patient go to ER to be admitted for surgery, and surgery  took place two days after initial visit. I was told in a seminar that the initial hospital code 99221-99223 appended with modifier can be used versus the office visit code 99203-99205. Does anyone have input if this would be correct?

This case is also a tough case for me. The patient was admitted for removal of failed Intermedullary rodding and replacement of rodding. This patient is one year status post intramedullary rodding of right roximal femur with hip screw into the femoral neck and head and the the xray taken in office two days ago shows hip screw has migrated superiorly through the cortex of the femoral head. Patient also has a periprosthetic femoral fracture with a long oblique fragment extending above the level of intramedullary rod. This patient fell about two weeks ago and xrays taken in the office showed a recent displaced spiral fracture of mid/distal shaft of femur. Operation performed was removal of intramedullary nail from right hip with revision and placement of new intramedullary rodding to the right femur fracture.

Can both procedures be coded the 2068 and I am unsure which code to use for the revision with replacement of intermedullary rodding. I am stuck between the 27506 and 27513. I also have a question about the icd9 code for failed femoral rodding would that be 996.49 or 996.40 with V code
Thanks in advance


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## Bella Cullen (Oct 18, 2010)

amartinez1 said:


> I have a patient that was seen in our physician's office and then he had patient go to ER to be admitted for surgery, and surgery  took place two days after initial visit. I was told in a seminar that the initial hospital code 99221-99223 appended with modifier can be used versus the office visit code 99203-99205. Does anyone have input if this would be correct?
> 
> This case is also a tough case for me. The patient was admitted for removal of failed Intermedullary rodding and replacement of rodding. This patient is one year status post intramedullary rodding of right roximal femur with hip screw into the femoral neck and head and the the xray taken in office two days ago shows hip screw has migrated superiorly through the cortex of the femoral head. Patient also has a periprosthetic femoral fracture with a long oblique fragment extending above the level of intramedullary rod. This patient fell about two weeks ago and xrays taken in the office showed a recent displaced spiral fracture of mid/distal shaft of femur. Operation performed was removal of intramedullary nail from right hip with revision and placement of new intramedullary rodding to the right femur fracture.
> 
> ...



Yes, if your doc saw the patient in the office then decided that same day to admit the patient then you only code for the admission...99221-99223. 
FYI, if surgery was the day of or the day after admission then the admission code gets a 57 modifier. If it was 2 days after admit then No modifier on the E/M.

For the surgery I would code as 27506, 20680-59 with dx 996.78. 

Hope that helps.


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## amartinez1 (Oct 18, 2010)

Thanks for your advice but I have a question about diagnosis of 996.78.
What is the difference between the 996.40/996.49 and the 996.78. Since the complications arised from her recent fall and caused a different fracture to the femur shaft?


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## Bella Cullen (Oct 18, 2010)

amartinez1 said:


> Thanks for your advice but I have a question about diagnosis of 996.78.
> What is the difference between the 996.40/996.49 and the 996.78. Since the complications arised from her recent fall and caused a different fracture to the femur shaft?



996.78 is just the dx I use when there is complications due to an internal ortho device. I never used 996.40/996.49. 
Also, you could use 998.59 which is for other post op complications.


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