Orthopedic Coding Alert

Question: Is there a procedure code other than 23929 (unlisted procedure, shoulder) to use for a closed reduction of a humerus fracture with percutaneous pinning?

Billene Richards
Spokane, Wash.

Answer: The key to accurate reporting of fracture care is obtaining the most accurate information possible about the type and location of the fracture and the method used for the restorative treatment. If necessary, review the operative report and question the surgeon to get the information you need to assign accurate diagnosis and procedure codes

For humeral fractures, you will need to know if the bone is fractured at the proximal portion (upper end), in the shaft (mid-section) or at the distal portion (lower end). Even this information is not sufficient because there are many classifications for proximal and distal humerus fractures. Once you have established an accurate diagnosis code, you can move on to choosing the correct procedure code. If the fracture is at the distal end of the humerus, CPT offers several options for reporting percutaneous fixation.

For a transcondylar or supracondylar fracture, use 24538 (percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension). For an epicondylar fracture, use 24566 (percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral, with manipulation), and for a fracture of the humeral condyle, the right choice is 24582 (percutaneous skeletal fixation of humeral condylar fracture, medial or lateral, with manipulation). Unfortunately, if the fracture is at the proximal end of the humerus or humeral shaft, you will need to report the appropriate unlisted procedure code and submit a special report with the claim.

Source for the above Reader Questions is Heidi Stout, CPC, coding and reimbursement specialist at University Orthopaedic Associates, a multispecialty orthopedic practice in New Brunswick, N.J.