Re: Please HELP! closed vs open reduction vs percutatneous....Marg...

They always have to normally do a reduction to line up the bones before
instrumentation can be placed. So saying closed reduction with IM nailing
means that they did an open treatment.

In your case if they did a closed reduction and percutaneously placed a
screw it could be a percutaneous fixation or it could be an open. In your
note it states "....Once that was done and fixed, we irrigated the wound with
copious amounts of normal saline, closed the wound with 4-0 Monocryl
suture. ..:" This could imply open treatment as there is reference to the
smaller percutaneous sites just having dermabond placed, which usually means it
did not go down very deep.
I would recommend that you double check with the surgeon

That is why many of the codes have been changed to just treatment of a
fracture using plates and screws or IM nailing.

Margie Scalley Vaught, CPC, COC, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR
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In a message dated 8/23/2016 9:13:27 A.M. Pacific Daylight Time,
lleal@coastalortho.net writes:

I'm a bit confused on this one. Can someone please help?
Is this closed reduction, open reduction or percutaneous?

The procedure performed heading indicates closed reduction and screw
fixation of lateral malleolus fracture. Doc indicates it is a closed reduction
with percutaneous fixation. Just double checking based on the description
of the procedure. Since two small incisions were made to rotate the
fragment, is this an open or closed reduction?

...... Under fluoroscopic guidance we made two small incisions to place
our abduction forceps. With the reduction forceps in hand we were able to
rotate the fragment into position and keep it reduced manually. We then
made a small incision distally. We placed a K-wire from distal to proximal,
overdrilled the near cortex and then placed a 70 mm 4.0 screw and we were
able to obtain good purchase proximally. Once that was done and fixed, we
irrigated the wound with copious amounts of normal saline, closed the wound
with 4-0 Monocryl suture. We placed Dermabond over the smaller incisions
and then injected the areas with plain Marcaine roughly 20 mL total. We
placed Betadine ointment and sterile dressing and Ace bandage. The patient
was then placed into a Cam boot. She was then awakened from anesthesia and
returned to the PACU in stable condition.

Comments

  • Verbally, he is indicating it was a closed reduction with percutaneous pinning but what I am a little confused about is that
    he is saying he made, "two small incisions to place our abduction forceps. With the reduction forceps in hand we were able to rotate the fragment into position and keep it reduced manually".

    Do the incisions have to be a certain size to consider this open or what is the rule for this?...and if I am coding closed reduction (27788) then what code do I use for the percutaneous pinning for the placement of the K wire and screw (do I use 27899).
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