Orthopedic Coding Alert

-Olive wire- will give you the answer you need every time If your surgeons use the term "uniplane" or "multiplane" in their external fixation op reports, count yourself among a lucky few. But if you-re like most coders and have to search for a few clues to decide between 20690 and 20692, our experts have the answers you need. Narrow Your Coding Options to 2 Two basic types of external fixation exist today: uniplanar and ring fixation, says Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C. Helpful: "Multiplane fixation and ring fixation are basically synonymous now," though there are exceptions, Mallon adds. "So if you see ring fixation mentioned, you should code for multiplane fixation." Your coding differs for uniplane and multiplane fixation, says Leslie Follebout, CPC-ORTHO, coding department supervisor at Peninsula Orthopaedic Associates in Salisbury, Md.: - Uniplane: You should report 20690 (Application of a uniplane [pins or wires in one plane], unilateral, external fixation system). - Multiplane: You should report 20692 (Application of a multiplane [pins or wires in more than one plane], unilateral, external fixation system [e.g., Ilizarov, Monticelli type]). Coders may find deciding between uniplanar and multiplanar codes to be tricky, Follebout says. But if you look for these clues in your op reports, you-ll be one step closer to choosing the proper code. Clue 1: If You Spot -Ilizarov- or Hybrid, You-re Home-Free Code 20692's descriptor includes Ilizarov and Monticelli types as examples of multiplane external fixation systems, so if you see either of these terms, you should home in on 20692. Ilizarov in focus: An Ilizarov system "looks like a series of bicycle wheels placed around the extremity (most often the leg), connected by thin wires," Mallon says. "The Ilizarov device is still available, but most trauma companies make a variant of it. You can look for the term Ilizarov, or ring fixation, but it may go by another name," he says. Hybrid tip: A hybrid is multiplanar because it combines a ring fixator and uniplanar fixator, Mallon says. Other terms, such as "spanning," which means "goes across a joint," don't help you determine whether to use the uniplane or multiplane code. Good news: There are a few more clues you can look for to keep you on the right track. Clue 2: Get a Fix on Fracture Location Surgeons use uniplane fixators almost exclusively for shaft fractures, especially midshaft tibia fractures, such as 823.20 (Fracture of tibia and fibula; shaft, closed; tibia alone) or 823.30 (- shaft, open; tibia alone), Mallon says. Surgeons typically fix most intra-articular fractures in the leg with ring fixation, Mallon says. These fractures include tibial plateau (knee) (such as 823.00, Fracture [...]