Wiki Help!!!Percutaneous pinning of articular middle phalanx fracture

[Jamie0330]

I am struggling to find a code for a percutaneous pinning of a middle phalanx articular fracture. The fracture is of the radial condyle of the middle phalanx, displaced.
The only 2 codes that I come up with are 26727 & 26742. Neither one completely describes the procedure performed. I can't find any thing to point me in the right direction either. I would hate to code 26989, unlisted. If someone has some insight or guidance on this.

Procedure ( the pertinent info)
Flouroscope was brought in. We were able to reduce the fracture using a pointed reduction bone clamp. Holding the fracture reduced with bone clamp, we then place a 0.2 K-wire across the fracture. We place a second K-wire across after removing bone clamp. We had anatomic reduction on the AP and lateral view. The pins were bent and cut. They were left outside the skin.

 

[Orthocoderpgu]

I'm not seeing one either for an articular fracture of the middle phalanx. I don't think that I have seen pinning of an articular fracture. My guess is that you will have to go unlisted. I think the documentation of the procedure could be better. Not sure if you have worked with your physicians or not. Our hand surgeon will always dictate the direction of the wires and the angle. There's basically no specificity here in the documentation.

 

[Jamie0330]

I'm not seeing one either for an articular fracture of the middle phalanx. I don't think that I have seen pinning of an articular fracture. My guess is that you will have to go unlisted. I think the documentation of the procedure could be better. Not sure if you have worked with your physicians or not. Our hand surgeon will always dictate the direction of the wires and the angle. There's basically no specificity here in the documentation.

I am not quite sure what the direction of the wires are needed for. We have a separately dictated x-ray report. Do you want to know if the wires cross the joint (DIP)? They do not cross the joint. They run perpendicular to the middle phalanx bone through the fracture site of the radial condyle. Does this help?

 

[Orthocoderpgu]

No, I would not expect them to cross. I've coded hundreds of these over the years for three hand surgeons and every one of them has much more specificity than this dictation does. So that's what I am used to seeing.