Wiki percutaneous fixation greater tuberosity fracture

[codergirl1222]

There's no direct CPT code for this procedure. It was done while the doctors were doing an arthroscopic procedure on the patient's shoulder and the doctor described the procedure as percutaneous fixation and put in guide wires across the fracture site. any ideas for cpt? thank you

 

[amandafletcher29@ymail.com]

Arthroscopic procedure

I am thinking one of two ways, and any replies that can confirm either or tell me the best way would be great, but I would think either an arthroscopic code with the modified procedure modifier (dont remember which it is right off hand) or an unlisted procedure code. Also, I would verify with the physician that they noted correctly because wouldn't a guidewire be considered internal fixation and not percutaneous? I am just out of school and havn't even recieved the results on my exam yet, so I really appriciate some guidence on whether this advice is right or wrong. My reply may sound stupid, but honestly this is how I would code it, and wouldn't know any better without the help of you guys.

 

[Bella Cullen]

There's no direct CPT code for this procedure. It was done while the doctors were doing an arthroscopic procedure on the patient's shoulder and the doctor described the procedure as percutaneous fixation and put in guide wires across the fracture site. any ideas for cpt? thank you

What was the arthroscopic shoulder procedure because the greater tuberosity is also on the shoulder so this might be inclusive to the arthroscopic procedure.
Did dr fix the greater tuberosity while he/she was performing the arthro procedure or was a separate incision made??? need to know more details. Thanks.
Bella

 

[codergirl1222]

patient broke her shoulder (displaced grtr tuberosity fx) and a fragment went into the rotator cuff area. she had full-thickness RCT and Bankart lesion.

RCR arthroscopic
Bankart repair arthroscopic
"percutaneous" fixation of GT fx-
removal of loose bodies arthroscopic

while fixing the rotator cuff (arthroscopically) the fracture reduced.

then op report reads "once this provisional reduction was obtained, cannulas were removed from the shoulder and fluoroscopic guidance was brought in. Under guidance 4.0 cannulated screw guidewires were placed across the GT fx. "

Screws and washers were then put across the fx

doesn't say any new incision was made but maybe 23630 with a modifier is the way to go. there's no code for arthroscopic fx repair procedures either.

i'm thinking the comment about was this really percutaneous or internal fixation is spot on! it's internal fixation!

 

[Bella Cullen]

patient broke her shoulder (displaced grtr tuberosity fx) and a fragment went into the rotator cuff area. she had full-thickness RCT and Bankart lesion.

RCR arthroscopic
Bankart repair arthroscopic
"percutaneous" fixation of GT fx-
removal of loose bodies arthroscopic

while fixing the rotator cuff (arthroscopically) the fracture reduced.

then op report reads "once this provisional reduction was obtained, cannulas were removed from the shoulder and fluoroscopic guidance was brought in. Under guidance 4.0 cannulated screw guidewires were placed across the GT fx. "

Screws and washers were then put across the fx

doesn't say any new incision was made but maybe 23630 with a modifier is the way to go. there's no code for arthroscopic fx repair procedures either.

i'm thinking the comment about was this really percutaneous or internal fixation is spot on! it's internal fixation!

I would say it is inclusive to the arthroscopic rotator cuff repair and is not billable. Also, you can't bill an open code for an arthroscopic procedure, if anything it would have to be unlisted arthroscopic procedure.
The only other thing you could do is maybe add a 22 modifier to the 29827 and increase the fee by 20% since there was more work involved due to the fx.