Orthopedic Coding Alert

Femoral fix can be accompanied by grafting, fixator codes.

Patients with broken femurs are in for a long road to recovery. Coders can prevent a long road to reimbursement for services by focusing on a few key elements of each femoral fracture repair claim.

You’ll have to be careful to choose the correct CPT^® codes, from diagnosis through surgery, in order to represent the services the surgeon provides.

Take a look at this advice on femoral fracture coding, and you’ll be able to better code claims for these patients.

E/M, Imaging Precede Surgery

Before the surgeon can treat a patient’s femoral fracture, they have to identify it. This typically starts with an evaluation and management (E/M) service along with X-rays or magnetic resonance imaging (MRI) scans.

You’ll code any physical exam services your surgeon provides before a femoral fracture fix with an evaluation and management (E/M) code, likely 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.). Be on the lookout for other types of E/Ms as well, though; the E/M could also be an inpatient code.

When the surgeon opts for X-rays or MRI scans, here are the most likely codes you’ll report for the service:

• 73501 (Radiologic examination, hip, unilateral, with pelvis when performed; 1 view) through 73525 (Radiologic examination, hip, arthrography, radiological supervision and interpretation)
• 73560 (Radiologic examination, knee; 1 or 2 views) through 73580 (Radiologic examination, knee, arthrography, radiological supervision and interpretation)
• 73721 (Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material)
• 73722 (… with contrast material(s))
• 73723 (… without contrast material(s), followed by contrast material(s) and further sequences)

Use These Codes for Proximal End Fixes

The selection of the appropriate surgical code for your patients with femoral fractures can get confusing fast, if you’re not focused on what you need to know.

“When selecting a code for a femoral fracture repair, remember to select the appropriate code based on the correct anatomical site of the fracture, followed by what approach the physician used, such as open, percutaneous, or closed,” says Wayne Conway, CPC, CRC, CGSC, COSC, CRC, surgical orthopedic coder at Wake Forest University Baptist/Atrium Health.

There are codes for femoral fracture fixes in two areas of the bone. When the surgeon repairs a femoral fracture at the proximal end of the femur, you’ll choose from the following CPT^® codes, depending on encounter specifics:

• 27230 (Closed treatment of femoral fracture, proximal end, neck; without manipulation)
• 27232 (… with manipulation, with or without skeletal traction)
• 27235 (Percutaneous skeletal fixation of femoral fracture, proximal end, neck)
• 27236 (Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement)

Explanation: Codes 27230 through 27236 are based anatomically on a femoral fracture involving the proximal end/neck of the femur. In addition, the codes are divided into the type of technique and approach used to repair the fracture,” explains Conway.

Use These Codes for Intertrochanteric/Peritrochanteric/Subtrochanteric Fx

If the femoral fracture repair isn’t for the proximal end of the femur, then it’s either intertrochanteric, peritrochanteric, or subtrochanteric. You’ll report these surgeries with one of the following codes, depending on encounter specifics:

• 27238 (Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulation)
• 27240 (… with manipulation, with or without skin or skeletal traction)
• 27244 (Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage)
• 27245 (… with intramedullary implant, with or without interlocking screws and/or cerclage)

“CPT^® codes 27238 through 27245 would involve the same type of treatments/approaches as codes 27230 through 27236,” relays Conway.

Remember to Look for These Separately Codeable Services

When you are coding for a femoral fracture, most (if not all) of the surgical work is wrapped up in the surgery codes. There are, however, opportunities to code other services that your orthopedist provided during the surgery, Conway says.

“If an auto bone graft is obtained and used, these could also be billed with the femoral fracture codes as grafts are not included in these codes. The application of an external fixator is also billable with these fracture codes if applied during treatment,” he explains.

For grafting or fixator application, choose one of the following codes, depending on encounter specifics:

• 20900 (Bone graft, any donor area; minor or small (eg, dowel or button))
• 20902 (… major or large)
• 20690 (Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system)
• 20692 (Application of a multiplane (pins or wires in more than 1 plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)).