Right Tibia Nonunion Fx
Need help coding the following procedure. Pt. sustained a proximal tibia fracture that was treated about 11/2 years ago with intramedullary nail. This was an open fracture. Patients fracture did not heal & was found to have infection. We placed antibiotic cement, & left that in for 6 weeks, then removed this & re-nailed. The patient again failed this fixation. This is a plated-assisted bone transport that was discussed with the patient. We started by removing the nail & made an incision through the old scar in the anterior aspect of the distal portion of the knee. We dissected through the patellar tendon down to the nail that was easily found & was sitting a bit prominent. We then removed our locking screws proximally & distally & extracted the nail. We opened up our nonunion site & resected proximal & distal to this about 1.5 cm on each side, getting down to clean noninfected bone. We then placed a Synthes medial plate. This was the longest one we could get; it was 301 mm. I left this a little bit distal to allow for a good transport segment. We locked this distally with 4 bicortical locking screws. We placed unicortical screws proximally holding the bone. We then pre-distracted our Nu Vasive Unyte nail to the length we had measured & discussed. We placed this down to the proper depth. I locked this distally using the freehand technique & then locked this proximally through the guide. We did have to change some of the proximal locking crews as they were id the path of 1 of the screws. We shortened these to accommodate for this. We then performed a corticotomy, first with a 40 drill bit finished with an osteotome. We obtained films showing a step-off of this, ensuring that our fracture was complete. We then did a 1.5 mm transport, & made sure on x-ray that we did see a change in both the osteotomy side with that distracting & in the nail with the stroke shortening. We then thoroughly irrigated with sterile saline & placed vancomycin powder in the resection osteotomy site. We closed & place bacitracin, adaptic, 4X4's & tape. I have looked at CPT 27720, 27705, 20680. Another coder has come up with 27759 & 27457 which I feel are incorrect. I would appreciate any help with coding this procedure. Would it just be an unlisted CPT?