Patient had a comminuted humeral shaft fx - 6 months later it has not healed. Doctor, in the opeartive report heading calls it a "nonunion" - but also later in the report under "findings" says there "malunion of butterfly fragment and proximal fragment". I gathered the bulk of the fx is "nonunion".
He states "Attempt at reduction was done, it did not appear to fit anatomically or in a manner conducive with open reduction and internal fixation. Therefore, decision was made to utilize a bur to create step osteotomies and the proximal and distal portions to allow for good bony apposition." He creates the step osteotomy down to good bleeding bone then reduces the osteotomy sites and clamps them in place. He then places a screw across the osteotomy site - then 8 hole plate was positioned. Bicortical, cortical and locking screew used to fix the plate.
Should I use 24515 Open treatment of humeral shaft fracture with plate/screws, with or without cerclage and add -22 modifier to since the added work of the osteotomy?
Or should we look at 24400 Osteotomy, humerus, with or without internal fixation?
I'm not understanding why the 24400 pays less - seems more work involved.
Any guidance would be greatly appreciated.
He states "Attempt at reduction was done, it did not appear to fit anatomically or in a manner conducive with open reduction and internal fixation. Therefore, decision was made to utilize a bur to create step osteotomies and the proximal and distal portions to allow for good bony apposition." He creates the step osteotomy down to good bleeding bone then reduces the osteotomy sites and clamps them in place. He then places a screw across the osteotomy site - then 8 hole plate was positioned. Bicortical, cortical and locking screew used to fix the plate.
Should I use 24515 Open treatment of humeral shaft fracture with plate/screws, with or without cerclage and add -22 modifier to since the added work of the osteotomy?
Or should we look at 24400 Osteotomy, humerus, with or without internal fixation?
I'm not understanding why the 24400 pays less - seems more work involved.
Any guidance would be greatly appreciated.