# Periprosthetic Fracture Femur-Vancoover B



## kathy a (Apr 18, 2012)

Having problems coding a surgery in which the patient had an ORIF of her left femur-she had a total hip replacement a month previous and had a prosthesis put in, so she no longer has her trochanters.Her diagnosis is peri-prosthetic fracture involving her prosthesis. Doctor replaced her prosthesis. Would you code this as an unlisted code? I have done research on this and the codes suggested to use were :

# 27236-which the doctor says is all wrong due to the type of prosthetic used.
He suggested # 27507- which I told him it was the shaft, which the break wasn't there, as it was around the proximal end, where the prosthesis was-so that would be incorrect.
I have seen where people have used # 27244- he said that would be closer-since he used a plate. This code states intertrochanteric, peritrochanteric, or subtrochanteric with plate/screw type implant.The problem is that she doesnt have any trochanters.
Any help would be greatly appreciated. 
Kathy Albert,CPC


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## hewitt (Apr 18, 2012)

It seems to me that your better (not best) choice is to use the closest CPT for what he has documented with an appropriate modifier. The appropriate ICD-9 codes would help clarify as well. Otherwise, the unlisted code may be your other option. This may not be the answer you were looking for, but you are in a tight spot.


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## kathy a (Apr 23, 2012)

Thanks...thats what I thought as well.   Kathy


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