Wiki Proximal humeral malunion/nonunion

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klienhart

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Hi all - Recently I have come along a couple of situations where the provider is taking a patient to surgery for a hemi-arthroplasty due to malunion or nonunion. Provider wants to bill 23616, however, this is for an acute fracture. The malunion/nonunion codes, 24430 and 24435, do not include a hemi-arthroplasty. So, would this be coded with 23470? Although it seems there is more work involved due to the malunion/nonunion to use 23470. Thanks in advance for any help.
 
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  • 23616 = doesn't necessarily mean "acute fracture." (The anatomical neck is the portion of the humerus that separates the greater and lesser tubercles from the humeral head, or the forearm muscles. The slightly narrowed or depressed area just below the greater and lesser tubercles is known as the surgical neck. A surgical or anatomical neck fracture is a crack in this upper end of the humerus bone. When the patient is appropriately prepped and anesthetized, the provider incises the skin over the fractured bone. He then dissects down through subcutaneous tissue, protecting the nerves and vessels. He retracts the muscles to have adequate exposure of the fracture. He then adjusts the bone to reduce, or realign, the fractured fragments. He may fix the fracture using implants such as screws, nails, or wires. He may also repair the tuberosity, or rounded projection, on the upper end of the humerus. In the case of a severe fracture, the provider replaces the upper end of the humerus bone with a synthetic humerus bone implant. For this, the provider clears the glenoid cavity and debrides it properly so that the humeral head can fit and rotate smoothly. Then he closes the wound by suturing the skin layers together. He then places the patient in a sling or brace for a period of four to six weeks to help with healing. He may perform a separately reportable X–ray examination of the upper end of the humerus to confirm the reduction of the fracture.)
  • 23470 = wouldn't be this code because that's for a partial shoulder replacement. Unless the op note supports that.
  • 24430 = is for the humerus (long upper arm limb) NOT the proximal humerus (anatomical neck, surgical neck, greater and lesser tubercles).
  • 24435 = same, it only involves the humerus not the proximal part.
It all depends on the work performed that's dictated in the op note. From the info you gave me I would say code 23616. The underlined part also includes the severity of the surgery/fracture.
 
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