General Surgery Coding Alert

Question: A patient came in for surgery to repair a percutaneous intra-articular proximal phalanx head fracture.

Here is a portion of the op note:

The patient was taken back to the OR and underwent anesthesia without complication. The right upper extremity was prepped and draped in the usual sterile fashion. A time-out occurred immediately prior to procedure identifying the correct patient, site, laterality, planned procedure, preoperative antibiotics, availability of equipment and availability of imaging. The arm was exsanguinated the tourniquet was insufflated to 250 mmHg. Initial fluoroscopic imaging demonstrated impacted fracture along the ulnar condyle of the right ring finger proximal phalanx head. On the lateral radiograph, there is more dorsal displacement of the impacted fracture. Traction was applied about the digit along with radial deviation through the PIP joint. Volarly directed pressure was applied about the proximal phalanx head. Orthogonal fluoroscopic imaging demonstrated concentric alignment of the intra-articular proximal phalanx head fracture. While holding reduction, a 0.045 K-wire was inserted in a retrograde fashion from the ulnar condyle to the radial condyle. K-wire was cut. Orthogonal fluoroscopic imaging demonstrated maintained reduction and appropriate K-wire positioning. Ring finger was brought through range of motion. No further scissoring. K-wire was then bent and further cut to size and Jurgan ball was applied. 10 cc of local anesthetic was injected about the right ring finger for digital nerve block. Sterile dressing consisting of Xeroform, 4x4s and Webril was applied. Patient was placed into a ulnar gutter splint with the inclusion of small and ring finger.

Our provider suggested I use 26746, but I don’t think that’s correct. Could you explain which codes I should use to report the surgery?

Florida Subscriber

Answer: You are correct in that the suggested code is wrong, but more on that in a bit. Assign 26727 (Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each) to report the surgery performed. The code doesn’t distinguish whether the fracture is articular, but it most accurately describes the procedure performed.

The documentation does not mention that the physician made an incision; therefore, you cannot use an open procedure code, such as 26746 (Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, each).

“The important thing is that if you don't make an incision and document it, you can’t bill for it. It helps to describe the incision in more detail than necessary to make sure the open code is documented,” says Noah Raizman, MD, MFA, CPC, at the Centers for Orthopaedics in Washington.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC