Surgical and Anesthesia Codes For Fracture and Dislocation
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Surgical and Anesthesia Codes For Fracture and Dislocation
Preoperative Diagnosis: Fracture with a slight dislocation at the base of the first proximal phalanx and ulnar collateral ligament avulsion from distal insertion on proximal phalanx (gamekeeper’s thumb).
Type of Anesthesia: Bier Block Anesthesia Provider: Anesthesiologist
Indications for Procedure: The patient is an 18-year-old male brought in for evaluation of his left thumb, which he fell on today and bent backwards. It is sore and swollen, especially along the medial aspect. I noted no tingling or paresthesias. The X-ray shows a fracture with a slight dislocation at the base of the first proximal phalanx.
Findings: The ecchymosis around the injury area looked resolved and older than two days. The fracture fragment, which had some adhesions, was flipped over about 160 degrees. It would not easily stay in a normal orientation due to the forces placed on it, so I could not do a repair by attaching it to the ulnar collateral ligament.
Instead, I removed the bone fragment and then repaired the ulnar collateral ligament stump directly to the debrided base of the wound, where a 2.1 mm Mitek had been set. I gave the patient a thumb spica splint made of fiberglass and custom-bolted it to his extremity with the thumb ulnarly deviated.
Perioperative Medications: 1 gram of Ancef preoperatively, 10 ml of 0.5% Sensorcaine postoperatively.
Narrative Summary: The patient was brought to the operating room after standard nursing preoperative identification, evaluation and counseling. The left upper extremity was prepared and draped in the usual orthopedic fashion. A curved incision was marked over the ulnar aspect of the metacarpal phalangeal joint of the thumb. The distal limb was volar enough to allow visualization of the volar ulnar portion of the joint.
Proximally, the wound was more dorsal. Soft tissue was dissected down to the subcutaneous layers, with care taken to remove any small nerves and blood vessels dorsally. The aponeurosis from the adductor was cut longitudinally just ulnar of its insertion into the extensor tendon. This was tagged with a suture for later identification and repair.
The capsule was then opened up in the dorsolateral to inspect the inside of the joint. The capsule and congruous ulnar collateral ligaments were easily seen with the bony fragment. This was debrided.
A 2.1 mm Mitek suture anchor was placed in the base of the debrided bony defect. Two holes were drilled through the bony fragment, through which sutures were run and reduced as much as possible. Sutures held tightly during an X-ray, which showed inadequate position and opposition of the bone fragment, confirming the visual data.
Therefore, the sutures were removed from the bone by backing out the needles. The bone fragment was carefully removed from the end of the ulnar collateral ligament by using a 15-blade scalpel.
The #2-0 Ethibond sutures were then tied through the ulnar collateral ligament in a locking knot, pulling the ulnar collateral ligament into the depth of the wound. This was directly inspected. The capsule was then repaired using more 2-0 Ethibond. The aponeurosis from the adductor was repaired using 5-0 Ethibond as well, reconnecting it to the side of the extensor tendon. Gentle range of motion showed the finger structures to be free.
The subcutaneous wound was then closed with several sutures followed by 5-0 nylon. The patient was given an injection for pain control and the ulnar gutter splint as noted above. He recovered from the anesthesia without problems and was returned to the recovery room.
Postoperative Diagnosis: Fracture with a slight dislocation at the base of the first proximal phalanx and ulnar collateral ligament avulsion from distal insertion on proximal phalanx (gamekeeper’s thumb).
ICD-9-CM Code
816.01 Fracture with a slight dislocation at the base of the first proximal phalanx and ulnar collateral ligament avulsion from distal insertion on proximal phalanx (gamekeeper’s thumb)
CPT Codes and Modifiers
For Medicare patients: 01830-AA Anesthesia for open procedures on radius, ulna, wrist or handbones; not otherwise specified For Non-Medicare patients: Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), with or without internal or external fixation
Rationale: When assigning CPT codes for anesthesia services, first determine what type of anesthesia is being administered and by whom. Medicare requires an anesthesia CPT code, while most other payers require the primary or principal surgical CPT code.
To locate the surgical code, look in the index of the CPT manual for the terms thumb, with dislocation, open treatment. The code listed is 26665, and the description supports your choice. Modifier -AA is assigned to reflect that an anesthesiologist provided the service.
If this was a Medicare case, take the surgical CPT code and use the American Society for Anesthesiologists’ crosswalk. Assign the appropriate anesthesia CPT code, and apply modifier -AA to indicate that an anesthesiologist provided the service.
Dawn Seelye is a senior health care consultant with Medical Learning Inc. (MedLearn®), St. Paul, MN.
