Wiki Non-union left fibula shaft

[dianegodfrey@comcast.net]

I am having a disagreement about which code to use, Dr., did a re-fusion left fibula with bone graft. The code that I think should be used is 27726 which states repair of fibula non-union and/or malunion with internal fixation. Since no internal fixation was used such as plate, screws etc.. modifier 52 reduced services could be appended. The other choice would be 27784 which states open treatment of proximal fibula or shaft fracture includes internal fixation when performed. I think that this code is for initial treatment of the fracture not treatment of non-union. There is a reference from AMA cpt assistant April 2009 that says if there is not a code available for nonunion/malunion repair of a specific site report appropriate fracture treatment code with modifier 22, increased procedural services. But there is a non-union code which is 27726 which is why I think this is the correct code and just add 52 for no hardware. If anyone can help with the correct answer would be appreciated.

 

[amyjph]

A couple questions since it's tough to answer without an op note. Was it the fibula shaft? We are not talking about the level of the ankle, correct? And, there was no tibia involvement? What led to the nonunion (smoking, co-morbid conditions, noncompliance?) and was there any internal fixation/hardware in there the first time? It's sort of more rare to have a stand alone fibula shaft fracture with no tibia involvement, not that it can't happen.
I agree if straight repair of a non/malunion of the fibula it is 27726. A note on the debate, if you look at the RVU for the 27784 you would probably end up with around the same amount if you append a 52 to the 27726. I see why the provider wouldn't want a 52 but the nonunion and malunion repair codes are meant to be used not the initial ORIF ones when it comes to this. And, since you are stating no hardware was used at all I see why you would append the 52.

 

[dianegodfrey@comcast.net]

Thank you for your response. The fracture was just the fibula shaft , it was not the ankle. There was no tibia involvement. The patient is 64 years old and just has poor bone healing ability. There was internal fixation at one time but it had been removed years ago by another doctor. I agree that 27726 should be used for the diagnosis of non-union with 52 modifier since no hardware used, also agree that 27784 is to be used if it was for the initial treatment. Thank you for the confirmation of the code that I thought should be used.

 

[amyjph]

Thank you for your response. The fracture was just the fibula shaft , it was not the ankle. There was no tibia involvement. The patient is 64 years old and just has poor bone healing ability. There was internal fixation at one time but it had been removed years ago by another doctor. I agree that 27726 should be used for the diagnosis of non-union with 52 modifier since no hardware used, also agree that 27784 is to be used if it was for the initial treatment. Thank you for the confirmation of the code that I thought should be used.

Interesting. Your description above brings more questions up. The original fracture was how long ago? And, if the hardware was removed "years ago" how does the patient have a non/malunion now? It almost sounds more like a new re-fracture or more like a stress fracture if it had healed at one time and the hardware was taken out that long ago. Without the op note it's hard to know. Or, more like an osteoporotic fracture. Is this person a runner?