Wiki Closed Reduction Percutaneous Pinning Intra-articular Proximal Phalanx Fracture

[MI_CODER]

What CPT code would you use for a closed reduction percutaneous pinning of an intra-articular proximal phalanx fracture?

A 0.035 k-wire was placed on the ulnar condyle and driven across the base to stabilize the intra-articular component. An additional .035 k-wire was then placed at the base of the left little finger proximal phalanx after flexing the digit to reduce the fracture. The pin was driven through the proximal segment and then across out the ulnar side. Rotation was also appropriate and alignment restored so we placed an additional pin ulnarly on the proximal phalanx condyle and drove it radially.

The software I use (3M) led me to 26742. The provider disagrees and feels that the procedure he performed is more difficult than 26742. He is wanting to use 26746. I don't agree with this code because the procedure was not an open procedure. He suggests using modifier 52 with 26746 but I also don't agree with this because the procedure was not reduced.

I'm still thinking that 26742 is the correct code. If not, maybe I should use an unlisted code?

Thanks in advance.

 

[sxcoder1]

I read this on the Professional Services Coding Forum http://medcodingforum.decisionhealth.com/search?Search=26742

 

[MI_CODER]

Thank you. This helps me out alot.

 

[sxcoder1]

As an FYI, I just discussed with my hand surgeon as he just had one of these and he said "the hand resources he has access to recommend 26746 as the clamps and pins are used to reduce the articular nature of the fx, which is significantly more than a closed treatment with manipulation, especially given the postop care required with subsequent in office procedure to remove pins." So I guess I'm going to code 26746!

 

[fish4codes]

I code for hand surgeons only and the code they would use for this would be 26727. Before you say, but this code does not state "articular"... yes, but this was not an open procedure either, so what reflects the work more accurately (GRAY area !!). I found additional resource at this link.. https://www.supercoder.com/my-ask-an-expert/topic/hand-injury

 

[sxcoder1]

Thank you for that suggestion and link as well. I definitely see what you're saying. My doctor was very adamant about using the 26746 though...

 

[AM4255]

This isn't the best answer anyone wants to hear since it does involve tedious work to get the payment deserved for closed reduction of an articular fracture with internal fixation when there is no code really for it. I just came across the situation of my surgeon doing just this procedure, he has pinning in two separate spots and the work for the definition of 26727 clearly is for one spot, but the only true accurate way to go about it would be billing the 26727, adding on 22 modifier and sending the operative report along with a short letter why we are requesting additional payment for the work. Which should be a promising pay out, as they are having to use internal fixation in two spots to stabilize both the joint and the phalanx and that goes beyond the work for 26727.

I also was thinking about coding 26727 for the phalanx and then also coding 20650 for the joint, since it technically is a different spot than the first insertion of pins. But I already know there is going to be a denial with 20650 included in 26727 and you will then need to send in a reconsideration letter on it. Either way, there is going to be some AR work. 26727,22 versus 26727 with 20650 calculates out to be the same amount paid as well.