dcallaway
Guest
Can someone point me in the right direction with which CPT code to use for this? Patient had a right distal fibula closed reduction and internal fixation with fibular IM nailing. The only thing I can come up with relatively close is 27759 but that is for the tibia. Below is a portion of the OP note. Thank you
The lateral aspect of the external fixator was removed to allow access for the placement of the fibular nail. The clamps and bars were all cleaned with alcohol after removal and my gloves were changed. Utilizing fluoroscopy the shaft of the fibula was marked in line to provide a guide for placement of the nail. A 1 cm incision was made distal to the fibula to allow for starting point the 1.6 mm guidewire was then placed at the tip of the fibula in line with the shaft of the fibula and verified fluoroscopically. Utilizing closed reduction techniques a guidewire was then passed past the comminuted fracture site into the proximal fibular shaft. Fluoroscopic images confirmed reduction and placement of the guidewire. The fracture comminution extended proximally to about 120 mm from the tip of the fibula. The shortest nail was 130 mm I felt this was not long enough to provide enough fixation so we went with the 180 mm nail. The opening reamer was then utilized ensuring that the reamer extended at least 3 mm within the tip of the fibula. The 3.2 mm reamer was then passed to the shaft of the fibula there was no chatter though I felt the 3.0 mm nail was adequate. I inserted to 3.0 x 180 mm nail without difficulty transversing the fracture site. Once nail was verified in good position and the syndesmosis guides were in appropriate position I then extended the tines of the proximal aspect of the nail to control rotation. I then utilized the 2 lateral to medial distal locking screws as well as the anterior to posterior distal locking screw. Screw placement and lengths were all verified fluoroscopically. Satisfied with the nail placement I then utilized the guide to drill for 2 syndesmotic screws under fluoroscopic guidance. The guide was then removed from the fibular nail and 2 syndesmotic tight ropes were then passed from lateral to medial flipping the distal fixation on the medial aspect. This was all verified fluoroscopically. I then sequentially tightened the tight rope until adequate syndesmotic fixation which was verified fluoroscopically. The sutures were then cut at the lateral button.
The lateral aspect of the external fixator was removed to allow access for the placement of the fibular nail. The clamps and bars were all cleaned with alcohol after removal and my gloves were changed. Utilizing fluoroscopy the shaft of the fibula was marked in line to provide a guide for placement of the nail. A 1 cm incision was made distal to the fibula to allow for starting point the 1.6 mm guidewire was then placed at the tip of the fibula in line with the shaft of the fibula and verified fluoroscopically. Utilizing closed reduction techniques a guidewire was then passed past the comminuted fracture site into the proximal fibular shaft. Fluoroscopic images confirmed reduction and placement of the guidewire. The fracture comminution extended proximally to about 120 mm from the tip of the fibula. The shortest nail was 130 mm I felt this was not long enough to provide enough fixation so we went with the 180 mm nail. The opening reamer was then utilized ensuring that the reamer extended at least 3 mm within the tip of the fibula. The 3.2 mm reamer was then passed to the shaft of the fibula there was no chatter though I felt the 3.0 mm nail was adequate. I inserted to 3.0 x 180 mm nail without difficulty transversing the fracture site. Once nail was verified in good position and the syndesmosis guides were in appropriate position I then extended the tines of the proximal aspect of the nail to control rotation. I then utilized the 2 lateral to medial distal locking screws as well as the anterior to posterior distal locking screw. Screw placement and lengths were all verified fluoroscopically. Satisfied with the nail placement I then utilized the guide to drill for 2 syndesmotic screws under fluoroscopic guidance. The guide was then removed from the fibular nail and 2 syndesmotic tight ropes were then passed from lateral to medial flipping the distal fixation on the medial aspect. This was all verified fluoroscopically. I then sequentially tightened the tight rope until adequate syndesmotic fixation which was verified fluoroscopically. The sutures were then cut at the lateral button.