Orthopedic Coding Alert

Question: How should I code the following report for the right elbow? Open reduction, internal fixation of a comminuted proximal ulnar fracture and radial head prosthesis with excision of radial head fragments. The diagnosis is comminuted fracture dislocation, Monteggia type.

California Subscriber

Answer: For the proximal ulnar fracture open reduction, internal fixation (ORIF), you should report 24685 (Open treatment of ulnar fracture proximal end [e.g., olecranon or coronoid process(es)], includes internal fixation when performed).

You should report 24666 (Open treatment of radial head or neck fracture, includes internal fixation or radial head excision when performed; with radial head prosthetic replacement) for the radial head fracture prosthesis.

The appropriate diagnosis code is 813.03 (Fracture of radius and ulna; upper end, closed; Monteggia's fracture).