1. Bridget Sheridan
   Posted 1 year ago #
   

   Ortho doc saw pt and billed 99223-57 and wants to charge 27840 on 01/23/11. He could not complete all that was needed and the next day returned to see pt in hospital and wants to bill 27822,28445, and 27620. Can we bill as specified above, or only for the E&M one day and the next day procedual charges and scrap the 27840?

2. SuperCoder
   Posted 1 year ago #
   

   I found a similar question in a 2010 Podiatry Coding Alert. I'll see if I can find additional information.

   Modifiers 57/58 Describe Two Fracture Surgeries

   Question: A patient presented to the emergency room and the podiatrist performed a closed reduction and manipulation for a trimalleolar ankle fracture. The closed reduction didn’t work so the DPM returned to surgery to repair the fracture the next day. How should I code both surgeries?

   Answer: You’ll need to code for three services: the initial visit and examination the first surgery, and the second surgery.

   If the patient was treated in the emergency room, choose from 99283-99285 (Emergency department visit for the evaluation and management of a patient …). If the patient was admitted to the hospital before the decision for surgery was made, instead report 99222 (Initial hospital care, per day, for the evaluation and management of a patient …). Append modifier 57 (Decision for surgery) to the correct E/M code.

   For the original ankle repair, submit 27818 (Closed treatment of trimalleolar ankle fracture; with manipulation). Include modifier LT (Left side) or RT (Right side) as appropriate.

   Submit 27822 (Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip) or 27823 (Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; with fixation of posterior lip) for the second surgery. Again, include either modifier LT or RT. Also append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) because the return procedure was more extensive than the original surgery.

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