Coding, Classification and Reimbursement

  • 1.  Percutaneous Pinning

    Posted 12-03-2018 16:54
    We are having difficulty in finding a CPT code for Percutaneous Pinning and Bone Grafting. We come up with unlisted code 20999 Unlisted procedure musculoskeletal system, general. Wondering if anyone else has come across this and if so what code was used. Thanks so much in advance.

    PRE/POSTOPERATIVE DIAGNOSIS: Right ankle septic nonunion.


    PROCEDURE IN DETAIL: Under mild sedation, the patient was brought back to the operating room and placed on the table in the supine position. After induction of general anesthesia, the right lower extremity was prepped surrounding all pin sites. The frame was carefully removed from the pins themselves and removed from the limb. There was found to be significant loosening of the distal tibia pin but the proximal pin remained stable. There was also found to be one of the calcaneus pins had broken within the calcaneus itself. All pieces were able to be removed. Next, pins were cut flush to skin and carefully removed without difficulty. There was no sign of draining or purulence at any of the pin sites. After removal of the frame and all pins, the right lower extremity was carefully scrubbed, prepped and draped in the usual sterile manner from the tips of the toes to the level of the knee. The limb was exsanguinated and tourniquet inflated to 300 mmHg.

    Attention was directed to the anterior ankle. Under fluoroscopic imaging, a guidewire was inserted from the anterior distal tibia into the talus. This was drilled using a cannulated drill bit and then a 2.4 mm Steinmann pin was inserted crossing the ankle joint. A second Steinmann pin was inserted in a similar fashion to provide further stability to the ankle joint arthrodesis. Next, under fluoroscopic guidance a guidewire was inserted into the anterior-medial ankle from an anterior approach. Several fluoroscopic views were taken to confirm placement through the area of suspected nonunion. The bone graft product with platelet derived growth factor was mixed on the back table. Approximately 1 cc was injected into this anterior-medial port after drilling with a 4-0 drill bit. Next, the guidewire was inserted into the anterior-lateral ankle arthrodesis and using fluoroscopic imaging to determine location. This was overdrilled with a 4-0 drill and an additional 1 cc of bone graft material was injected. Next, the guidewire was inserted medially from the immediate posterior medial malleolus into the posterior ankle arthrodesis site. A cannulated drill was used to fenestrate this area over the wire and an additional 2 cc of bone graft material were injected to the posterior ankle site. Next, all incisions were closed with 3-0 nylon suture. All pin sites were left open at this time. Clean, dry sterile dressings were applied. The patient was placed in a well-padded dressing. He was placed into a CAM walker boot at that time. The Steinmann pins were left in place.

    [Karen] [Y]