OLCG79
New
Good afternoon,
I need help with a cpt code for an internal joint stabilizer-elbow. My provider wants to bill 20692. (20692-Application of a multiplane (pins or wires in more than 1 plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type). I don't agree with this cpt code since the description states external but I can't fine one for an internal. I was thinking on using an unspecified code 24999 and compare to 20692.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and laid supine on the operating room table with a hand table assist. All bony prominences were well padded. A general anesthetic was induced and the arm was prepped and draped in normal, sterile fashion, utilizing a sterile tourniquet on the arm. A time out was taken that included reading the consent aloud, which was available on the chart, confirming the operative site and laterality, and ensuring that all operative personnel agreed with the time out.
We began by exsanguinating the affected extremity with an Esmarch wrap and raising pneumatic tourniquet to 250 mmHg where it remained for the requisite portion of the procedure.
A skin marker was used to mark the planned incision and/or relevant landmarks. A 15- blade was used to make the incision, which was made in line from midpoint between the lateral epicondyle and the tip of the olecranon from the lateral epicondyle down to the forearm. Incision was extended as necessary to complete exposure.Full-thickness flaps were developed both anteriorly and posteriorly. A traumatic rent, if visible, was utilized for exposure of the radial head. The extensor muscles were elevated off the humerus as appropriate. Care was taken to hold the forearm in pronation and protect the posterior interosseous nerve throughout the procedure.
All fracture fragments, including, but not limited to, the radial head were excised as appropriate. The radial head was not reconstructed. The coronoid was found to be fracture with avulsion adhered to the anterior capsule. We were able to utilize a fiber tack suture anchor to reduce the fracture and the capsule to enhance stability. Articular surface was found to be impacted posteriorly at the posterior rim of the capitellum consistent with a previous fracture dislocation. Copious irrigation was utilized to flush any debris fragments.
Utilizing the canal finder, the radial neck was prepared. The fracture was trimmed or planed as necessary. Sequential broaching was conducted until prosthetic fit. The radial head was measured and fluoroscopic imaging ensured no overstuffing of the radial head arthroplasty. There was no block to pronation–supination arc of motion or flexion–extension arc of motion.
We then turned our attention to placement of the internal joint stabilizer as the elbow was highly unstable. A transcondylar pin was placed under fluoroscopic guidance along the transcondylar axis. Care was taken not to breach the ulnar aspect of the humerus. A length appropriate rotation pin was then placed. Under fluoroscopic imaging, the baseplate was then secured to the proximal ulna. Care was taken to avoid intra-articular perforation of the joint or impingement against the radial head arthroplasty. The boom arm and hinge pin were then placed with the arm at 90 degrees with compression against the ulnar humeral articulation. Once secured, full range of motion was conducted without any evidence of instability. This was done under fluoroscopic guidance as well.
The internal joint stabilizer was utilized in order to obviate the need for an external fixation device as an alternative.
I need help with a cpt code for an internal joint stabilizer-elbow. My provider wants to bill 20692. (20692-Application of a multiplane (pins or wires in more than 1 plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type). I don't agree with this cpt code since the description states external but I can't fine one for an internal. I was thinking on using an unspecified code 24999 and compare to 20692.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and laid supine on the operating room table with a hand table assist. All bony prominences were well padded. A general anesthetic was induced and the arm was prepped and draped in normal, sterile fashion, utilizing a sterile tourniquet on the arm. A time out was taken that included reading the consent aloud, which was available on the chart, confirming the operative site and laterality, and ensuring that all operative personnel agreed with the time out.
We began by exsanguinating the affected extremity with an Esmarch wrap and raising pneumatic tourniquet to 250 mmHg where it remained for the requisite portion of the procedure.
A skin marker was used to mark the planned incision and/or relevant landmarks. A 15- blade was used to make the incision, which was made in line from midpoint between the lateral epicondyle and the tip of the olecranon from the lateral epicondyle down to the forearm. Incision was extended as necessary to complete exposure.Full-thickness flaps were developed both anteriorly and posteriorly. A traumatic rent, if visible, was utilized for exposure of the radial head. The extensor muscles were elevated off the humerus as appropriate. Care was taken to hold the forearm in pronation and protect the posterior interosseous nerve throughout the procedure.
All fracture fragments, including, but not limited to, the radial head were excised as appropriate. The radial head was not reconstructed. The coronoid was found to be fracture with avulsion adhered to the anterior capsule. We were able to utilize a fiber tack suture anchor to reduce the fracture and the capsule to enhance stability. Articular surface was found to be impacted posteriorly at the posterior rim of the capitellum consistent with a previous fracture dislocation. Copious irrigation was utilized to flush any debris fragments.
Utilizing the canal finder, the radial neck was prepared. The fracture was trimmed or planed as necessary. Sequential broaching was conducted until prosthetic fit. The radial head was measured and fluoroscopic imaging ensured no overstuffing of the radial head arthroplasty. There was no block to pronation–supination arc of motion or flexion–extension arc of motion.
We then turned our attention to placement of the internal joint stabilizer as the elbow was highly unstable. A transcondylar pin was placed under fluoroscopic guidance along the transcondylar axis. Care was taken not to breach the ulnar aspect of the humerus. A length appropriate rotation pin was then placed. Under fluoroscopic imaging, the baseplate was then secured to the proximal ulna. Care was taken to avoid intra-articular perforation of the joint or impingement against the radial head arthroplasty. The boom arm and hinge pin were then placed with the arm at 90 degrees with compression against the ulnar humeral articulation. Once secured, full range of motion was conducted without any evidence of instability. This was done under fluoroscopic guidance as well.
The internal joint stabilizer was utilized in order to obviate the need for an external fixation device as an alternative.