# External fixation



## coders_rock! (Dec 16, 2011)

MY DOCTOR BILLED 

*26746* - Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, each 

but, INSTEAD OF INTERNAL FIXATION, HE USED AN EXTERNAL EXTERNAL FIXATION ON THE SAME JOINT, IS SHE ABLE TO BILL THE EXTERNAL FIXATION SEPARATE, IF SO, WHAT CODE WOULD I USE/

THANK YOU,


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## OCD_coder (Dec 16, 2011)

You would use the uniplane code 20690 for a MTP or IP ORIF.  The multiplane code are for longer bones like your tibia or fibula, femur etc.

Hope that helps.


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## coders_rock! (Dec 19, 2011)

Here is the portion of the op-note for billing the external fixation. Now do you think 20690 is applicable?

The fracture was mobilized and was noted to be comminuted and approximately free of fragments.  This was not amenable to K-wire fixation.  Therefore, it decided to use sutures to hold the fracture in place.  The PIP joint was noted to be dislocated volarly and it was decided to use an external fixator to fix this.  Using 0.045 K-wires, three K-wires were placed transversely across the finger, first in the head of the proximal phalanx and 2 more distally in the shaft of the middle phalanx.  Position of the K-wires were noted to be good.  The K-wires were then bent to give some dynamic dorsal pressure to the middle phalanx and this allowed the joint to be reduced nicely.  The joint was reduced nicely and it was felt that the rubber band fixation would not be necessary for this.

FYI: this was done on the little (pinky) finger.


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## suec (Jun 18, 2019)

did you resolve this issue?  Is a dynamic or hinged external fixator for the middle phalanx considered an external fixation and coded with 20690?  Seems it might be more the lines of a splint and not coded with a closed reduction of the same bone.


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