christinec
New
Hello, we have a hand surgeon who is wanting to bill open fracture code 24685 for removal of a fractured osteophytes (and coding the diagnosis as a fracture instead of an osteophyte).
Here is an example. Please let us know what you think:
OPERATIVE PROCEDURE: Open treatment of left elbow olecranon traction osteophyte/enthesophyte fracture, without internal fixation. We began by performing a curvilinear incision around the olecranon. Full-thickness skin flaps were raised, and we raised full-thickness skin flaps. We identified the olecranon, and the large traction osteophyte/enthesophyte. This was dissected circumferentially, and we took great care not to go any further medially than the olecranon to avoid injury to the ulnar nerve. We inspected the fracture site, and found that the enthesophyte was quite mobile still, signifying that it had not healed, and explaining the patient's severe pain. We did not have to incise the triceps tendon in order to identify the enthesophyte over the fracture. Fluoroscopic guidance was used to identify the fracture plane, and the traction osteophyte/enthesophyte was debrided using a rongeur. We debrided down to smooth bleeding healthy olecranon bone. Fluoroscopic views verified a smooth olecranon, with excision of the fracture fragment. Tourniquet was let down, hemostasis was achieved using electrocautery, the wound was irrigated thoroughly, and the skin was closed using 3-0 nylon sutures.
What code would you apply for this?
Here is an example. Please let us know what you think:
OPERATIVE PROCEDURE: Open treatment of left elbow olecranon traction osteophyte/enthesophyte fracture, without internal fixation. We began by performing a curvilinear incision around the olecranon. Full-thickness skin flaps were raised, and we raised full-thickness skin flaps. We identified the olecranon, and the large traction osteophyte/enthesophyte. This was dissected circumferentially, and we took great care not to go any further medially than the olecranon to avoid injury to the ulnar nerve. We inspected the fracture site, and found that the enthesophyte was quite mobile still, signifying that it had not healed, and explaining the patient's severe pain. We did not have to incise the triceps tendon in order to identify the enthesophyte over the fracture. Fluoroscopic guidance was used to identify the fracture plane, and the traction osteophyte/enthesophyte was debrided using a rongeur. We debrided down to smooth bleeding healthy olecranon bone. Fluoroscopic views verified a smooth olecranon, with excision of the fracture fragment. Tourniquet was let down, hemostasis was achieved using electrocautery, the wound was irrigated thoroughly, and the skin was closed using 3-0 nylon sutures.
What code would you apply for this?