# ORIF of periprosthetic femur fracture



## lorrib

Hi,

I am hoping someone can help me with an Open Reduction and Internal Fixation, for a periprosthetic femur fracture.  Here is the Op note:

Diagnosis:  Periprosthetic right femur fracture (patient has a right total hip arthroplasty)

Procedure:  Open reduction and internal fixation, right periprosthetic femur fracture at the hip.

The patient was brought to the operating room.  Her Old incision which was lateral was utilized.  The incision was carried through skin, subcutaneous tissue, through the fascia lata.  The gluteus medius was left intact.  Predominantly the incision was made in the vastus lateralis and extending it up to the level of the greater trocahanter and just proximal and then reflecting the tissue anteriorly and posteriorly to visualize the fracture.  She had a large medial spike to her femur.  She had fairly brisk bone bleeding and reducing her medial spike with a Lowman clamp controlled her blood loss.  The fracture was readily reducible.  Two bone cortical graft pieces were utilized and three 2.0 cables were placed, the most proximal one was____, the two distal ones were stainless and cerclage wires were placed carefully around securing the two bone struts.  They were tightened, the more lateral of the 2 struts did crack during tightening.  The reduction visualized appeared quite good.  Some cancellous bone from encountering of the struts was available and that was used for grafting as well.  The wound was copiously irrigated. Hemostasis is controlled throughout the case with electrocautery.  Her fascia was closed with a nonabsorbable braided suture in layers.  Subcutaneous closed with Vicryl and Stratafix.  Skin was cloased with staples.

I am thinking the cpt code should be 27244 but I don't see where a plate was utilized for the internal fixation and the physician appears to have used bone grafting?  

Any assistance provided would be greatly appreciated.

Thank you,
Lorri


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## abbycat333

*Periprosthetic femoral fracture coding*

A periprosthetic femoral fracture in a patient with an existing THR, occurs almost always in the shaft of the femur, near the site of the tip of the stem. This is where the bone may be weakest, The op report you just shared does not specify the location of the break very well. I would first check with the provider to verify that the medial spike was located at the shaft. You would not use 27244, since this is to be used only for pertrochanteric fractures. This is ORIF of femoral shaft fracture, but I would use the unlisted code 27599, since neither of the ORIF femoral shaft codes mention fixation via bone struts and cerclage only. You can use 27507 however, as a reference to the carrier, of the basis of your fee. Be sure to use the diagnosis code for a periprosthetic fracture, along with the femoral shaft diagnosis code, and the V code for THR.


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## lorrib

*More info*

Hi,

Thank you so much for your input.  I did query the physician regarding where the large medial spike to the femur had occured and he indicated that this was proximal on the femur.  He also indicated that he performed an ORIF of the proxima fumur. I did look up that code, 27236, and I am wondering what your opinion is now with this new info?  I am still wondering about the two bone cortical graft pieces that were used?  Can I steal a little more of your time and knowledge?

thank you,
Lorri


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