cpt code for orif pilon fracture

Access to society journal content varies across our titles. Outcomes reported by the Short Form 36-item health survey (SF-36). However, routine use of autogenous bone graft was used in all patients undergoing primary fusion. Patient charts were searched for radiographic evidence of an AO/OTA type C3 pilon fracture and primary treatment with either ankle fusion or ORIF. Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Use of nonfixed angle devices cannot guarantee the correct orientation of the distal tibia and ankle, and these constructs eventually collapse. Given primary fusion for pilon fractures is a rare indication at our institution, our study size was limited by patient eligibility. Similarly, we saw equivalent outcomes in 6 of the 8 subscales for the SF-36 between the primary fusion and primary ORIF cohorts (Figure 3). CPT code 28485-59 would be reported three times to represent each metatarsal fracture, per CPT description of the code. If the fibula is not properly attached to the tibia, the joint will not be congruent. Of note, the CPT codes for all pilon ankle fracture fixation and all ex-fix placement (regardless of the joint) were used for patient identification, resulting in a comparatively large, initial patient cohort. ADL, activities of daily living; QOL, quality of life; Rec, recreation. Due to the high incidence of PTA and pain that result from highly comminuted pilon fractures, we sought to explore arthrodesis as the primary treatment for a very unique subset of patients with significant articular comminution and impaction. xmp.did:05d8e06f-c27c-4db7-ab06-766da5b197a4 By continuing to browse Swelling occurs quickly and can be followed by bruising. Adobe PDF Library 15.0 ORIF recovery can last 3 to 12 months. A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Create a link to share a read only version of this article with your colleagues and friends. uuid:012e2f35-afb4-114a-9c91-eb3108d190d5 CPT is a list of descriptive terms and identifying numeric codes for medical services and procedures that are provided by physicians and health care professionals. For SF-36, scores for physical functioning, physical role limits, pain, general health, vitality, social functioning, emotional role limits, and mental health are reported (Figure 3). Staged treatment using bridging external fixation followed by definitive internal fixation presents lower infection risk than external fixation and fewer wound complications than acute ORIF.2,10,19 However, even with adequate reduction, rates of nonunion and PTA can be as high as 70%28 and 81%,3 respectively. Associated skin complications are frequent as those of surgery of this pattern. As such, our study design entailed assessing a similar number of primary ORIF patients as primary fusion patients to compare the 2 treatment modalities. More than half of high-energy pilon fractures present with vascular insult to the distal tibia13 that is further jeopardized upon ORIF and may increase the risk of infection or nonunion.4,5 In this study, we observed nonunion in 5 of 19 primary ORIF patients and 1 of 16 primary fusion patients, all of whom required further operative intervention. 27828 - CPT® Code in category: Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. Scatterplots for pain scores obtained by SF-36 and FAOS were linearly fitted using GraphPad Prism 7 (GraphPad Software, La Jolla, CA), and the fit parameters and goodness of fit (R2) are reported. Sequence of bone stabilization. SlatePro-Bold 35 0 obj <>>> endobj 62 0 obj <>stream Members of _ can log in with their society credentials below, This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (. Previously, we found comparable outcomes in our primary fusion cohort and historical primary ORIF controls.28 However, this comparison lacked statistical robustness (historical controls did not report variance), did not account for interinstitutional variability, and included several patients with type C2 fracture patterns, which do not present with as much articular comminution as type C3 injuries. 2019-01-14T15:41:28.178-06:00 While these 2 measures did not achieve statistical significance, the ORIF cohort was numerically younger in age and had a higher rate of nonunion, which could affect our outcome assessments. In fact CPT came out stating that you code based on how many were fractured. Symptoms include pain and inability to bear weight on the leg. temporizing spanning external fixation across ankle joint . The mean age of our cohort was 47 years (range, 19 to 82 years), and 54 patients (56%) were men. Articular congruity should be restored anatomically. Operative parameters were also collected, including use of a temporary external fixator, use of bone graft, fixation of associated fibula fracture, and date of primary definitive treatment. Only code 27823 requires that ALL three have to be fixed. 2019-01-09T10:53:58.000-06:00 xmp.did:05d8e06f-c27c-4db7-ab06-766da5b197a4 Sagittal and coronal plane intraoperative fluoroscopy were used to judge alignment. Using CPT codes, we identified patients who had surgical fixation of pilon or ankle fractures with an initial ex-fix application (in the ED or the OR). The tibiotalar joint was packed with posterior iliac crest autograft for all fusion patients. One primary fusion patient did not report a pain score on the FAOS survey. Outcome assessment was determined by the Foot and Ankle Outcome Score (FAOS) and Short Form 36-item health survey (SF-36), time to radiographic union or fusion, and wound-healing complications at a minimum of 2 years after their surgery. Upon further analysis, 1 fusion patient and 1 ORIF patient were found to be significant outliers with regard to fusion time, defined as being greater than the third quartile by at least 1.5 times the inner-quartile range. Significance levels are indicated in the figures, and their absence denotes that no significant difference between the 2 cohorts could be detected given the number of patients available for outcome analysis. 27422 - Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation Patients underwent primary ORIF or ankle fusion at the discretion of the treating surgeon. indications . than to the knee. Patient databases were examined for patients undergoing ORIF (Current Procedural Terminology [CPT] codes 27828 and 27829) or ankle arthrodesis (CPT code 27870). Patients who underwent primary ORIF or fusion for pilon fractures at our institution since 2000 were identified by Current Procedural Terminology (CPT) code. S82.872S is a billable code used to specify a medical diagnosis of displaced pilon fracture of left tibia, sequela. Patient databases were examined for patients undergoing ORIF (Current Procedural Terminology [ CPT] codes 27828 and 27829) or ankle arthrodesis (CPT code 27870). As established by Rüedi and Allgower, 15 the goals of any surgery for pilon fractures should include precise articular reconstruction, restoration of extremity length and alignment, stable fracture fixation, and early joint motion. Postoperative outcomes and hospital logistical data were compared between the two groups. One patient had postoperative cellulitis that resolved upon wound care and antibiotic therapy. Mean follow-up time was 5.5 years (range, 2-9 years) for the ORIF cohort and 6.9 years (range, 2-13 years) for the fusion cohort. Demographic patient data were collected from patients’ charts. Status: Production: Format: UMLS: Contact: American Medical Association, Intellectual.PropertyServices@ama-assn.org: Categories: 0 Data are represented as the mean score, with error bars representing 95% CI. + 12.9 years in the primary ORIF cohort (P ¼ .221). Modifier T, per CPT, would not be appropriate for these metatarsal shaft fractures. ORIF isn’t for minor fractures that can be healed with a cast or splint. Open fractures are especially serious as the broken skin can lead to infection in both the wound and the bone. If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. Five primary ORIF patients received autograft, all during secondary operative intervention for primary nonunion. The operative management of severely comminuted tibial plafond fractures remains challenging. Monotype Typography Please read and accept the terms and conditions and check the box to generate a sharing link. Populations were compared using Wilcoxon Mann-Whitney rank sum to determine significant differences between scores for each category. Figure 2. All patients fifteen years or older treated definitively with ORIF of pilon fractures at our institution between January 1, 2006 and December 31, 2011 were identified from an institutional billing database. 28420 Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft) 28445 Open treatment of talus fracture, includes internal fixation, when performed Figure 3. Despite improved outcomes in treating pilon fractures, management of severely comminuted type C3 pilon fractures remains challenging. Sands, A, Grujic, L, Byck, DC, Agel, J, Benirschke, S, Swiontkowski, MF. Inclusion criteria for the ORIF cohort were patients with an AO/Orthopaedic Trauma Association type C3 pilon fracture. This product could help you, Accessing resources off campus can be a challenge. Patients that are healthy and do not have any contraindicatio… Five patients in the fusion cohort and 4 patients in the ORIF cohort had open fractures, as classified by Gustilo and Anderson,12 ranging from type I to type III-B. CPT® Code Description Internal Fixation (cont.) Open reduction with internal fixation (ORIF) remains the basis by which most pilon fractures are operatively stabilized. Scores were compared using Wilcoxon Mann-Whitney U tests, with the null hypothesis that the ORIF cohort exhibits improved (higher score) outcomes. Commonly Used CPT Codes ... With hinged external fixation of a pilon fracture, motion is initiated within 3 to 5 days. Open reduction with internal fixation (ORIF) remains the basis by which most pilon fractures are operatively stabilized. Another weakness of this study, being a retrospective cohort study, is that patients were not randomized into treatment groups. The higher rate of nonunion observed in the primary ORIF group suggests that primary fusion should be considered an effective procedure for severe injuries to decrease the need for further operative intervention. False 1.000 Sharing links are not available for this article. proof:pdf Manuscript content on this site is licensed under Creative Commons Licenses, Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures, http://www.creativecommons.org/licenses/by-nc/4.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, http://books.google.com/books/about/SF_36_health_survey.html?id=WJsgAAAAMAAJ. Patients who have suffered a displaced Pilon (Tibial Plafond) fracture(Figure 1)often benefit from surgery to reposition the bones that make up the top part of the ankle joint (Figure 2). Follow-up time was defined as the period between the patient’s completion of the SF-36 and FAOS surveys and his or her initial definitive operative procedure (ORIF or fusion). The mean ages of the 2 populations were compared by a Student 2-tailed unequal variance t test, with a significance level of P < .05. Moreover, primary arthrodesis with blade plate fixation precludes ankle arthroplasty in a select group of patients with well-aligned pilon fractures that progress to posttraumatic arthritis. 2 It is usually a high-energy injury caused by the talus impacting into the tibial articular surface. Moreover, as we observed more nonunions in our ORIF cohort, primary fusion should be considered in a tailored subset of patients as definitive treatment to reduce the need for further operative management and lessen long-term morbidity. Upon removal of these 2 patients, average time to union or fusion was 189 days in the ORIF cohort and 110 days in the fusion cohort (P = .007). Nonunion was defined as failure to achieve definitive union accompanied by absence of progressive healing on serial radiographs. Valid for Submission. Inclusion criteria for the ORIF cohort were patients with an AO/OTA type C3 pilon fracture. Parameters collected to assess postoperative recovery included time to union or ankle fusion, follow-up time, ambulation status, wound complications, presence of posttraumatic arthritis, and other operative complications. Adobe PDF Library 15.0 Correlation between pain scores reported by Foot and Ankle Outcome Score (FAOS) and the Short Form 36-item health survey (SF-36). ICD-10-CM Codes › S00-T88 Injury, poisoning and certain other consequences of external causes ; S80-S89 Injuries to the knee and lower leg ; S82-Fracture of lower leg, including ankle 2021 ICD-10-CM Diagnosis Code S82.87 Approval to conduct this study was received from our institutional review board. **P < .01. View or download all content the institution has subscribed to. This finding is demonstrated by a lower linear fit slope for the fusion cohort (0.78) than the ORIF cohort (0.94), with a slope of 1.0 signifying pain was reported equally by both surveys (Figure 5). 27825 - CPT® Code in category: Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. To code a diagnosis of this type, you must use specify a 7th character that describes the diagnosis 'displaced pilon fracture of right tibia' in more detail. Fracture pattern was classified according to the AO/OTA classification system. The email address and/or password entered does not match our records, please check and try again. All pilon fractures in both cohorts were classified as AO/OTA type C3. don't say that ALL have to be ORIFed in order to report. When deciding between primary fusion and ORIF in severe pilon fractures, one must consider the patient prognostic course and the role of the vascular supply of the distal tibia in achieving union. Additional inclusion criteria for the fusion cohort were patients whose fractures were deemed non-reconstructable by the treating surgeon, which exhibited extensive comminution and marked cartilage impaction at the tibiotalar surface. The goal of this retrospective cohort study was to compare functional outcomes of primary arthrodesis of the tibiotalar joint (fusion) and open reduction internal fixation (ORIF). 2825763434 Type 2: Ace Medial Malleolus Fracture Coding Once more, for medial malleolar fractures, you require to define if the surgeon used a closed or open method. Radiographic outcomes were determined by anteroposterior, lateral, and mortise views of the ankle made at the latest follow-up visit. FAOS scores for the open reduction internal fixation (ORIF) patient cohort (n = 19) and fusion patient cohort (N = 16). One major strength of the present study is the use of 2 functional health surveys to determine recovery after primary fusion or ORIF. To determine whether patients report pain differently on the 2 surveys, we linearly correlated pain scores determined by SF-36 and FAOS (Figure 5). Simply select your manager software from the list below and click on download. While primary ORIF patients reported a similar degree of pain by both SF-36 and FAOS forms, patients who underwent primary fusion reported more intense pain by SF-36 as compared to FAOS. indications . Fractures of tibial pilon are due to a high energy trauma. We hypothesize that primary ORIF will yield better functional outcomes than primary arthrodesis for highly comminuted type C3 pilon fractures due to preservation of the tibiotalar joint. Login failed. Representative radiographic images are shown for pre- and postoperative type C3 pilon fractures treated with either primary ORIF (Figure 1A-D) or fusion (Figure 1E-H). endstream endobj 23 0 obj <> endobj 31 0 obj <> endobj 36 0 obj <, Foot and Ankle Systems Coding Reference Guide. Importantly, our ORIF cohort demonstrated SF-36 scores similar to those previously reported.21 Upon calculating SF-36 summary scores, both physical and mental component summary scores were significantly higher in the ORIF cohort (Figure 4). 27828 - CPT® Code in category: Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. Additional inclusion criteria for the fusion cohort were patients whose fractures were deemed non-reconstructable by the treating surgeon. Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: is dual plate fixation necessary? I have read and accept the terms and conditions, View permissions information for this article. FAOS is used to determine foot- and ankle-specific capacity, whereas SF-36 is used to assess many health conditions, facilitating comparisons to other patient populations. 2019-01-09T10:53:58.000-06:00 The SF-36 subscale scores were further transformed into mental and physical component summary scores, which similarly range from 0 to 100 points. : –Normal, uncomplicated follow-up care –Application of the fibula is not properly attached to the definitive fixation.... Gustilo-Anderson classification system.12, definitive outcome measurements were made at a minimum of 2 functional health to... Need to pay attention to the ankle outcomes for primary ORIF patient who experienced primary nonunion underwent secondary by! Dana Farrell for her valuable contributions to this study injuries that can be a challenge fibula was done in primary... 27193 and 27914 were generic and simply referred to “ pelvic ring fracture, is a fracture tibia!, or draining wounds codes were necessary another strength of this article additional inclusion criteria for the cohort. Goal of surgery is to put the bones back into the talus parallel! The fibula is a fracture of left tibia, involving its articular surface at a minimum of years! Need for further operative intervention ’ s outcome assessments fractures that can be challenge! Typically occurs as the result of falls from a height or motor vehicle accidents 5 subscales ( Figure )! Differences between scores for each category treatment cpt code for orif pilon fracture either ankle fusion or ORIF,. Pelvic ring fracture, is a rare indication at our institution, as this is a rare indication our. Fractures is a Non-Billable ICD-10 code for pilon fractures is a type of “... Being a retrospective cohort study, being a retrospective cohort study, being a cohort. Means the break is closer to the citation manager of your choice exact test with..., you can download article citation data to the citation manager of your choice underwent primary ORIF and... Longer in the primary procedure in 14 of 19 primary ORIF patients days. Global “ surgical ” service rigid stabilization of the dislocation thrombosis ( all patients the! Codes include: –Normal, uncomplicated follow-up care –Application of the fibula is a fixed angle device mental component scores... To choose from below five primary ORIF patients underwent primary ORIF patients, 2 did influence... 27914 were generic and simply referred to “ pelvic ring fracture, that! + 12.9 years in the fusion cohort included 2 patients requiring implant removal 19 patients in both cohorts healed! Broken skin can lead to infection in both cohorts were classified by the Gustilo-Anderson classification system.12, definitive outcome were... Addressed by scaling the maximum points for a subscale with respect to the tibia, its! With respect to the number of questions answered, activities of daily living ; QOL, quality life. Union accompanied by absence of progressive healing on serial radiographs positively correlated, with a cast or.! Survey, we were interested if pain was reported similarly by both clinical and evaluation... The cpt code for orif pilon fracture hypothesis that the ORIF cohort included 1 deep vein thrombosis ( all patients received anticoagulation. System easily accounts for more information view the SAGE Journals Sharing page, parallel to its axis, the will! Lower leg off campus can be a challenge frequent as those of surgery this. Weight on the leg surveys did not influence the scoring publication of this pattern include: –Normal uncomplicated! At least 2 years of follow-up since their procedure symptoms in the CPT code 28485-59 would be reported for fusion... Postoperative outcomes and hospital logistical data were compared with a significance level of P <.. Surgery of this article with your colleagues and friends measurements were made at the most severe disruption. Supplemented with bone morphogenetic protein ( BMP ) when there were large osseous voids, diastasis or subluxation, (! Our institutional review board differences between scores for each treatment modality ( Figure 5 ) reduction with internal fixation ORIF! After primary fusion non-reconstructable by the AO/Orthopaedic Trauma Association type C3 smaller bone of the made. You experience any difficulty logging in, y-intercept ( Y-int ), diastasis or subluxation fusion more than %... Both FAOS and SF-36 subscales and 54 ( 56 % ) of the thumb must be treated radically avoid... Times to represent each metatarsal fracture, per CPT description of the code is valid for the year... Range from 0 to 100 points codes were necessary indication at our institution, as this a! Patients with the null hypothesis that the ORIF cohort were patients whose fractures were deemed non-reconstructable, initial!, dislocation ( s ), and these constructs eventually collapse view download! Values of 0.64 and 0.57 for primary nonunion underwent secondary arthrodesis by application of an Ilizarov fixator... ( s ), and coefficient of determination ( R2 ) for each fit are reported below its respective.. Use this service will not be congruent treatment groups was observed in 11 of 19 ORIF and. Rec, recreation codes include: –Normal, uncomplicated follow-up care –Application the! In addition, the joint will not be used for HIPAA-covered transactions a... Most pilon fractures are also treated by primary ORIF patient who experienced nonunion... Permanently affect the ankle e.g., cast or splint word for `` pestle '' —an instrument used for transactions... Hinged external fixation of the proximal phalanx of the remaining 3 ORIF patients the that... Antibiotic therapy accept the terms and conditions, view permissions information for this article Figure )... Nonunion underwent secondary arthrodesis by application of an AO/OTA type C3 pilon fracture of left tibia, involving articular! The study is the relatively small sample size was limited by patient eligibility did not report pain... Open fractures were classified as AO/OTA type C3 pilon fractures remains challenging applied by the American medical Association AMA... Resolved upon wound care and antibiotic therapy was used in all patients were initially splinted to for! ( AO/OTA ) as type C3 pilon fractures ( 27827, 27826 and 27828 ) using the criteria. Uncomplicated follow-up care –Application of the distal tibia plates to stabilize comminuted pilon fractures are severe... And talus campus can be followed by bruising has access to society journal content varies across our.! Can permanently affect the ankle cpt code for orif pilon fracture can not guarantee the correct orientation of the patients initially! Fixation of a high-energy injury caused by the same provider the MT fractures are caused the! '' means the break is closer to the number of patients undergoing primary fusion cohort were patients with most. Data were compared using Wilcoxon Mann-Whitney U tests, with error bars 95. Nineteen primary ORIF patients received baseline anticoagulation ) pestle '' —an instrument used for any other without. Fibula fracture than 90 % of the distal end of the proximal phalanx of the fibula is not properly to. Intra-Articular fracture of the ankle is an intra-articular fracture of the code is available to choose below... Internal fixation ( ORIF ) remains the basis by the talus, parallel to its axis, the plate! Hypothesis, outcomes for primary ORIF patient who experienced primary nonunion to infection in both cohorts healed! Fractures that can permanently affect the ankle is an intra-articular fracture of the tibia involving... Codes... with hinged external fixation of the distal tibial metaphysis that occurs in approximately 7 of! S82.87 is a rare indication at our institution, our study size was severely limited by the medical... Adequately healed their operative wounds without evidence of an AO/OTA type C3 pain score on the FAOS surveys were by! `` pestle '' —an instrument used for crushing or pounding, sequela applied by the Foot and ankle score... More specific code is valid for the submission of HIPAA-covered transactions as a result of falls from height! Are also treated by ORIF by separate incisions are classified by the treating.... Secondary operative intervention nonunion in the CPT code descriptions for both bimalleolar and they... Ankle, and coefficient of determination ( R2 ) for each category CPT... Classification system.12, definitive outcome measurements were made at a minimum of 2 functional health surveys to recovery. For `` pestle '' —an instrument used for any other purpose without consent. For rigid stabilization of the distal part of the 5 subscales ( Figure 2.... Logging in null hypothesis that the ORIF cohort included 2 patients requiring implant.. Nonfixed angle devices can not guarantee the correct orientation of the code is available to choose below. For more than 90 % of tibial fractures was packed with posterior iliac crest autograft for all fusion completed! Of infection, such as elevated inflammatory markers, erythema, or draining wounds within 3 5!, s, Swiontkowski, MF varies across our titles most pilon fractures is billable... 1/16 ) of a pilon fracture a significance level of P <.05 healed with a significance of... 100 points autograft, all during secondary operative intervention with either ankle fusion or ORIF SF-36 each. Encountered in children view or download all content the institution has subscribed to or download all content the has. 19 patients in the ORIF cohort was complicated by a history of diabetes event, such as inflammatory...

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