Intraoperative fracture
A small chip fracture of the left distal femur occurred during a left total knee arthroplasty. According to the operative report, "We put the tibial component in first, banged it into place and once that was done, put the femur on, banged it into place with a mallet and we still had a little looseness laterally. We pushed it on and got it down, but we noticed that there was a small piece of bone that had pulled off of the femur laterally”. An x-ray at the end of the procedure showed there was no propagation of the fracture into the femur. Bone putty was placed in the area prior to closing the quadriceps. The surgeon does note in the beginning of the procedure that while pinning the distal femoral cutting guide the bone was very osteoporotic. It was very easy to put the pins in, and we were able to get them out of the femur by hand.
Disorders associated with osteoporosis (M80) is listed in the Excludes 2 note under category M96 – Intraoperative and postprocedural complications and disorders of musculoskeletal system.
Can the fracture be coded to M96.662 and M80.052 or is a query needed to clarify if the fracture is a complication of the procedure?
Appreciate any advice.
Comments
As the record states the bone is 'very osteoporotic', it may that this fracture was not avoidable; also, the fracture is stated as "small" w/o 'propagation of the fx into the femur'.
I do not see any measures were directed specifically to the small fracture in osteoporotic bone - unless it was the putty?
As such, it is questionable if the fracture meets the definition of a reportable condition. This could be considered 'integral' to the procedure, unavoidable, and perhaps not clinically significant?
Below is some sample language re: 'complication'
Please clarify the relationship, if any, between the diagnosis and surgical procedure:
Provider Query Response
Incidental occurrence inherent to the surgical procedure
This should be considered a complication of the procedure
Unable to determine
Other (please specify)*