Wiki 24515 vs 24430

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such78

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DX: left humerus shaft fracture nonunion ( injury was in 2019)

Procedure: open reduction, internal fixation of left humeral shaft nonunion. Debridement left humeral fracture.

A longitudinal incision was made, just lateral to the biceps muscle. The bovie was used to cauterize any bleeders. The brachialis muscle was then split to visualize the humeral bone. this incision was carried down to the bone to allow better visualization of the fractures and to excise any necrotic soft tissue and bone within the fracture region. Cultures of the wound were taken before and after the antibiotic irrigation.

The fracture nonunion was then visualized. Callus and fibrous tissue were seen at fracture end. The fibrous tissues were removed with a curette and rongeus. The fracture was then reduced, and held with bone clamps. Using AO technique, and interfragment screw was placed, securing the reduction of the fractures. A straight plate was placed anterolaterally. Multiple bicortial screws were placed proximal and distal to the fracture site, securing the plate to the bone and further stabilizing the fracture.


Question:

Is it correct to assign 24430 for nonunion ORIF for left humerus based on the dx ( It didn't indicate the bone was divided through the nonunion)?

24515 seems fit this procedure because it was not indicated the bone was divided through the nonunion, but the it is conflicted with the dx as nonunion.



Please advice. Thank you.
 
suchang78 said:
DX: left humerus shaft fracture nonunion ( injury was in 2019)

Procedure: open reduction, internal fixation of left humeral shaft nonunion. Debridement left humeral fracture.

A longitudinal incision was made, just lateral to the biceps muscle. The bovie was used to cauterize any bleeders. The brachialis muscle was then split to visualize the humeral bone. this incision was carried down to the bone to allow better visualization of the fractures and to excise any necrotic soft tissue and bone within the fracture region. Cultures of the wound were taken before and after the antibiotic irrigation.

The fracture nonunion was then visualized. Callus and fibrous tissue were seen at fracture end. The fibrous tissues were removed with a curette and rongeus. The fracture was then reduced, and held with bone clamps. Using AO technique, and interfragment screw was placed, securing the reduction of the fractures. A straight plate was placed anterolaterally. Multiple bicortial screws were placed proximal and distal to the fracture site, securing the plate to the bone and further stabilizing the fracture.


Question:

Is it correct to assign 24430 for nonunion ORIF for left humerus based on the dx ( It didn't indicate the bone was divided through the nonunion)?

24515 seems fit this procedure because it was not indicated the bone was divided through the nonunion, but the it is conflicted with the dx as nonunion.



Please advice. Thank you.
Click to expand...
Your doctor has documented this as a non-union in both the diagnosis section of the op note, and the body of the op note. Code 24430 is supported.
 
suchang78 said:
When I use K code and it gives me as subsequent. The ORIF is the initial treatment for the patient.
Click to expand...
I know, I understand, but the surgeon is treating a fracture which has already healed and has healed as a non-union fracture. The patient is getting treatment for a non-union fracture so you need to use a non-union diagnosis. I know that "A" is normally used until the patient has restorative treatment, but this patient never received treatment and the fracture went on to non-union.
 
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