Open treatment involves two scenarios: 1) Surgical exposure of the fractured bone, where the bone ends are seen and possibly secured with internal fixation; or 2) Opening the bone away from the fracture site to insert an intramedullary nail, without directly visualizing the fracture site. For example, during surgery for a broken femur, the surgeon might make an incision to directly access and fix the broken bone ends, or they might insert a rod inside the femur without opening the fracture site itself.
Closed treatment, on the other hand, does not involve surgically opening the fracture site. It includes three approaches: 1) Treating the fracture without any physical adjustment; 2) Realigning the bone with manipulation; or 3) Applying traction, which can be with or without manipulating the bone. An example of closed treatment is using a cast to immobilize a broken wrist without any surgical intervention.
Percutaneous skeletal fixation is a middle ground between open and closed treatments. In this method, fixation devices like pins are inserted through the skin to stabilize the fracture, typically guided by X-ray imaging, but the bone is not directly exposed or visualized. This might be used in a case like a hip fracture, where pins are inserted through small incisions under X-ray guidance.
It’s important to note that the type of fracture (open, compound, closed) doesn’t directly correlate with the treatment type (closed, open, percutaneous).
Treatment codes vary based on the method of realignment (reduction) and stabilization (fixation or immobilization), and they apply to both open and closed fractures or joint injuries.
Skeletal traction involves attaching a wire, pin, screw, or clamp directly to the bone to apply a force, whereas skin traction uses straps applied to the skin. External fixation uses skeletal pins and an external device for treating bone deformities.
If a graft (like bone, cartilage, tendon) is obtained through a separate incision and not included in the main procedure, specific codes are used. If a fracture or dislocation needs to be realigned again by the same physician, a modifier 76 is added to the procedure code. Codes for internal fixation are only used if external fixation isn’t part of the primary procedure.