AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2022 Issue 2; Ask the Editor

Limb Lengthening Surgery

A 14-year-old female with left limb length discrepancy and tibial procurvatum deformity, presents for tibia-fibula osteotomy, anterior compartment fasciotomy, syndesmotic screw fixation, and application of a Hexapod external fixator. During surgery, a small incision was made along the lateral distal fibula, and a syndesmotic screw was placed over a guidewire through the tibia and fibula securing both bones. Next, a 3cm incision was made over the lateral mid fibula; tenotomy was used to dissect down to the fibula; 4mm fibular osteotomy was removed. Through a separate 1cm incision lateral to the tibial crest, a fasciotome was used to make an anterior compartment percutaneous fasciotomy 3cm from the ankle joint. The incisions were closed in layers. Two additional small incisions were made along the tibia, one lateral and one posterior with dissection down to soft tissue at both sites. A Luque wire was passed subperiosteally from medial to lateral, brought through the lateral incision, then passed back medially again and then secured. For frame application, an Ilizarov™ wire was placed percutaneously proximal to the tibial joint line. The Orthofix® ring was then hung off the wire, and the pins were placed over a guidewire. After securing all pins, the distal ring was secured into the diaphysis. Next, a percutaneous Gigli saw osteotomy was performed on the tibia. After completion of the osteotomy, the frame was assembled using struts, and then all incisions and pin sites were closed and dressed. Would the correct root operation for the placement of the limb lengthening device be Insertion or Reposition? Are separate codes assigned for the tibia/fibula osteotomies, fasciotomy and syndesmotic screw fixation? What are the appropriate code assignments for this surgery? ...

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