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Orthopedic Coding Alert

Reader Questions:

New Hip Fracture above Old

Published on Fri Jan 01, 1999

Question: A patient presents with a subcapital hip fracture above retained dynamic condylar screw (DCS) hardware (from a previous fracture). The surgeon performs a bipolar hemi-arthroplasty, removes the old hardware, and applies a cortical strut allograft with cable fixation. We need to know how we can code the graft in addition to 27236 for the arthroplasty and 20680 for the hardware removal?

ORC subscriber, Johnstown, PA

Answer: Using 27236 (ORIF or open reduction internal fixation of proximal femoral fracture) is correct for the arthroplasty, and it includes the use of bone allograft and cable fixation. The additional code 20680, for the removal of the retained hardware, can be used, but a 59 modifier (distinct procedural service) may be necessary to bill these together.
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