# Left radial head replacement/ left coronoid process fracture excision 24366??



## MELJNBBRB (Feb 18, 2015)

Hi list
Still newbie learning a new specialty of Ortho, how fun 

Would you  only code 24366?

TIA
MB,CCS,CPC


PREPROCEDURE DIAGNOSIS(ES):
1.  Left displaced intracapsular radial head fracture.
2. Left coronoid process fracture

POSTPROCEDURE DIAGNOSIS(ES):
Same

PROCEDURE PERFORMED:
1.  Left  radial head replacement ( SBI, modular ).
2.  Left coronoid process fracture excision

SURGEON:


ASSISTANT:


ANESTHESIA:
LMA.

ESTIMATED BLOOD LOSS:
30 cc

FLUIDS:
Per anesthesia record

FINDINGS:
Displaced intracapsular radial head/neck fracture.
Good bone and tissue quality for age.
Head size 4, standard neck -length, stem size 4

SUMMARY:
Following appropriate informed consent, patient identification, and
operative limb, the patient was brought to the operative suite where smooth
induction of LMA anesthesia was accomplished by anesthesiology service, and 
received broad-spectrum IV antibiotic prophylaxis. The arm wasprepped and draped in 
usual sterile fashion. Elbow motion blocks noted as above. Fluoroscopy was used to  
evaluate the elbow and radial head fragments, noting the comminuted/displaced  
Mason 3 fracture. A lateral extensor splitting approach to the elbow was carried out. 
The elbow joint capsule was then incised superolaterally with anterior and posterior 
flaps elevated, conserving the LCL posteriorly. There was blood in the joint with a severely comminuted radial head/neck fracture noted with wide displacement and rotation of several large fragments anteromedially, precluding ORIF. These fragments were removed and reconstructed on the field to confirm complete resection as well as estimate RH size at size 4. The coronoid process fracture was visualized and was a small avulsion type 1 fracture. ORIF was not needed and the fragment was excised. Proximal radius IM canal was then broached up to a size 4 stem referencing the radial styloid for the curved stem. Final trial size as noted above was selected for satisfactory fit with full, unimpeded elbow radio-capitellar articulation in all ranges of motion and confirmed with fluoroscopy to avoid overstuffing the RC joint. The trial components were removed and the wound was copiously lavaged. All debris/hematoma was removed. The radial head prosthesis was then press-fit into position. There was excellent stability in all ranges of motion and rotation with no pistoning/subluxation. The wrist was stable and ulnar variance confirmed as neutral. The procedure was terminated and the annular ligament and extensors were then reapproximated in layered fashion with absorbable sutures. A superficial layered absorbable suture/demabond closure was then performed and a sterile 
nonadherent dressing applied. The patient was extubated and transported to the recovery area in stable condition. There were no intraoperative complications


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## dclark7 (Feb 24, 2015)

I would use 24666 (Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed: with radial head prosthetic replacement), since this describes the treatment of the fracture as well as the radial head replacement.


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