# Articular Fracture Proximal Phalanx



## coderguy1939 (Apr 7, 2009)

I keep struggling with this one, so I'm hoping someone has so definetive information on how to code this.

Doctor did a closed reduction of an articular fracture of the proximal phalanx and placed two percutaneous k-wires.  I'm looking at 26742 but how do you get the k-wires?  Are they billed as supplies?  Would it be better to use an unlisted code?  Help!!!


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## KatieGal (Apr 8, 2009)

Look at code 26727 - as it states "percutaneous pinning" this would be the K-wires.  

Per the Coders Desk Reference - " The physician treats a phalangeal shaft fracture of the proximal or middle phalanx, finger, or thumb with manipulation and secures it with a wire".

Kate, CPC, COSC


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## Bella Cullen (Apr 8, 2009)

I agree with katiegal.


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## coderguy1939 (Apr 8, 2009)

This is an articular fracture which would place it at the proximal phalanx joint, so I don't think shaft fracture would apply.


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## Bella Cullen (Apr 9, 2009)

Maybe look at 26706 in CDR it says, the physician manipulates a metacarpophalangeal dislocation to restore anatomical position and secures the bone with a wire. The physician determines the dislocated position of the bone. The bone is relocated to correct anatomical position using external manipulation. The physician drills a wire into the metacarpophalangeal joint, through the fracture, and into the proximal bone. The drill entry point is dressed and the hand is splinted. And I got the definitions of dislocation fracture and articular fracture, and I think this one might work for you, by reading those. What do you think? I hope that helps. If not, then I guess it would be unlisted. 
 
*dislocation fracture*
Type: Term

Definitions:
1. a fracture of a bone near an articulation with a concomitant dislocation of the adjacent joint.


*articular fracture*
Type: Term

Definitions:
1. a fracture involving the joint surface of a bone.


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## coderguy1939 (Apr 17, 2009)

Thanks for all your input on this one.  I'm going with an unlisted code.


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## pmaho (Apr 20, 2009)

If the fracture/dislocation is at the metacarpalphalangeal joint (MTP), PIP or DIP, then 26742.

Patrick


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