AHA Coding Clinic® for HCPCS - 2019 Quarter 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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Article Overview
This premium coding article focuses on orthopedic fracture revision involving tibial nonunion repair and autologous bone grafting. It is intended for coders and revenue cycle professionals who work with musculoskeletal surgery documentation and need to understand how the case is analyzed for procedure reporting. The article addresses the clinical scenario, the operative steps described in the record, and the coding considerations relevant to this type of revision surgery.
Why This Topic Matters
Nonunion repair cases often require careful review of the operative note to distinguish the main fracture work from related revision activities. Understanding how this type of tibial surgery is documented helps support accurate procedure selection and consistent orthopedic coding review.
What You Will Learn
- How a tibial fracture nonunion repair case is described in operative documentation
- What aspects of the revision surgery are relevant to coding review
- How autologous bone grafting is discussed in the context of orthopedic fracture repair
- What documentation elements matter when evaluating post-fixation fracture revision cases
Who Should Read This
- Medical coders
- Orthopedic surgery coders
- Coding auditors
- Revenue cycle staff
- Clinical documentation review teams
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