What CPT (Current Procedural Terminology) code(s) are reported for a patient with a left femoral shaft fracture treated with Open Reduction Internal Fixation (ORIF) of the left femur with an intramedullary nail and interlocking screws, and a plaster splint application?

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CPT Coding for ORIF of Left Femoral Shaft Fracture with Intramedullary Nail and Plaster Splint

The correct CPT code for this procedure is 27506, which represents open reduction and internal fixation of a femoral shaft fracture with intramedullary implant with or without interlocking screws and cerclage.

Procedure Analysis

To determine the correct CPT code for this case, we need to analyze the key components of the procedure:

  1. Fracture Location: Left femoral shaft fracture in three places
  2. Procedure Type: Open Reduction Internal Fixation (ORIF)
  3. Implant Used: Intramedullary nail with interlocking screws (placed peritrochanterically)
  4. Additional Procedure: Application of plaster splint

Code Selection Rationale

The primary procedure is the ORIF of the femoral shaft fracture using an intramedullary nail. The CPT code that specifically addresses this procedure is:

  • 27506: Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws

This code accurately captures the open treatment of the femoral shaft fracture with intramedullary nail fixation, including the interlocking screws.

Why Other Codes Are Incorrect

  • 27245: This code is for treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fractures with intramedullary implant - not appropriate for a femoral shaft fracture.

  • 27507,29505: Code 27507 is for open treatment of femoral shaft fracture with plate/screws (not intramedullary nail). Code 29505 is for application of a long leg splint. This combination doesn't accurately describe the procedure performed.

  • 27513,29505: Code 27513 is for open treatment of femoral supracondylar or transcondylar fracture with interlocking nails - not appropriate for a shaft fracture. Code 29505 is for application of a long leg splint.

Important Coding Considerations

  1. The plaster splint application is considered part of the global surgical package for the ORIF procedure and is not separately reportable.

  2. The location of the interlocking screws being placed "peritrochanterically" does not change the fact that this is a femoral shaft fracture repair, as the primary fracture site is in the femoral shaft.

  3. The presence of multiple fracture sites (three places) does not change the CPT code selection as long as they are all in the femoral shaft and treated in a single procedure.

Therefore, the correct CPT code for this procedure is 27506.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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