# Cement fixation



## Rufus186 (May 18, 2017)

Is bone cement considered internal fixation?  Thanks


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## AlanPechacek (May 18, 2017)

That would depend on the circumstances in which is being used.  As a "Stand alone" method of fixation, then probably not.  Very rarely would it be used alone.  But there are circumstances where it may be used as an adjunct to other fixation devices, such as filling a large bone defect from a metastatic lesion with cement to provide additional support to the fixation used.

I hope this helps some.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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## Rufus186 (May 18, 2017)

Thank you Dr Pechacek, In this case a distal femoral lesion was curetted and left a defect (pt is status post TKR) so for support the physician packed with methylmethacrylate cement.  I was thinking cpt 27355, +27358 but my physician now states the biopsy results came back and it is malignant so he does not believe we can use 27355.  I thought as a physician coder you code per op note and at the time of service it was diagnosed as a femoral erosive lesion?


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## daedolos (May 18, 2017)

Rufus186 said:


> Thank you Dr Pechacek, In this case a distal femoral lesion was curetted and left a defect (pt is status post TKR) so for support the physician packed with methylmethacrylate cement.  I was thinking cpt 27355, +27358



https://www.aapc.com/memberarea/forums/42549-bone-cement.html

Plus this one.

https://www.aapc.com/memberarea/forums/144313-cpt-27358-vs-27495-a.html

Thank you, Dr Pechacek, for further elaboration.  This all helps for when I start coding surgeries soon.

Peace
@_*


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## Orthocoderpgu (May 18, 2017)

*Code per bx or path results*

As coders we are taught to occasionally wait for pathology or biopsy results before coding. I would consider this one of them. Any time I see tissue sent for pathology, I always wait for the results before coding since this will influence the coding process.


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## AlanPechacek (May 19, 2017)

At the present, I am at a meeting and did not bring my CPT Coding book with me, so I can't review the procedural codes you mention.  In essence, you will probably have to redo your Diagnosis Code based on the pathology report.  The procedure turns out to be the Curettage of the malignant lesion of the distal femur, and filling the defect with cement as opposed to a bone graft.  In that way/use, the cement is not "Internal Fixation" in the usual sense of the term.  When I get home, I will look at the CPT codes and try to help more.

The note above is wise in that when a specimen is sent for pathology, then you need to wait for the report, and/or be ready to revise your coding.

Will get back to this when I can.

Sincerely, Alan Pechacek, M.D.


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## AlanPechacek (May 22, 2017)

Having done more research on the possible CPT Codes for use in this case, the more difficult it is to solve.  As it turns out, the final pathology was that the lesion was malignant.  But, none of the codes for treatment of a malignant lesion of the distal femur apply as  they require "radical resection" of the lesion, which was not done in this case.  The procedure actually done is best described in the codes for treatment of a benign tumor or lesion, i.e. "curettage" of the lesion in the distal femur.  The 27355 code alone is not adequate by itself since the remaining cavity was filled with cement.  However, Cement is not an Allograft or Bone Substitute (which would be defined as a material that would eventually be converted to bone in the long term healing process of the lesion), so although 27356 is not totally correct either, it is the closest to what was done.  I think that in order to add 27358 to 27355 it would require that some form of metal fixation would have to have been placed in addition to the cement.  After cogitating on it, my best thought is to use 27599: Unlisted procedure of the femur, and pair it to 27356.  I would justify that by the fact that the lesion turned out to be malignant, none of the procedure codes for malignant lesions are correct, and the closest procedure to what was in fact done was 27356.  Of course, send all the documentation you have.

I would be interested to know what others might think/suggest.

Sincerely, Alan Pechacek, M.D.


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## Rufus186 (May 23, 2017)

Thanks so much Dr. Pechacek for your time and effort in this procedure. Your help is so very appreciated, your insight helps me in future coding as well.  I dont think I would have looked at 27356 as a comparable without it and if makes sense. 
 I worked on this again yesterday and was unable to find a code for this procedure as well except for unlisted.


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## AlanPechacek (May 23, 2017)

Rufus186 said:


> Thanks so much Dr. Pechacek for your time and effort in this procedure. Your help is so very appreciated, your insight helps me in future coding as well.  I dont think I would have looked at 27356 as a comparable without it and if makes sense.
> I worked on this again yesterday and was unable to find a code for this procedure as well except for unlisted.



You are welcome.  Glad to be of help.
Alan Pechacek, M.D.


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