AHA Coding Clinic® for HCPCS - 2019 Issue 4; Ask the Editor

Nonunion repair of the tibia with autologous bone graft

A patient who previously underwent an open reduction, internal fixation (ORIF) due to an ankle fracture presented with collapse of the fracture with displacement, hardware failure and a syndesmosis disruption. The patient was taken to the operating room for revision which included repair of the nonunion of the right tibia with bone grafting. After the previous hardware was removed, it was noted that there was extensive callus formation around the old fracture site with shortening and displacement. This was freed up and the callus formation, early bone formation and scar tissue were resected. The bone was saved for bone graft. Once the fibula was plated, a clamp was placed across the fibula and tibia and they were able to be compressed together and lined up for screw placement from the fibula into the tibia through the plate. The previously collected bone graft was placed medially in the medial malleolus prior to placing the screws. How do you report repair of nonunion of a tibial fracture with autologous bone graft when the bone graft is taken from the same incision site? In CPT code 27724, it appears the bone graft would be taken from another site (iliac or other autograft), where CPT code 27722, specifies a sliding graft. ...

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