If your orthopedic surgeon reports 20690 (Application of a uniplane [pins or wires in one plane], unilateral, external fixation system) for pin or wire insertion with other procedures, you may be in for a surprise.
The latest version of the National Correct Coding Initiative (NCCI) makes it clear that you-d better have a good reason to separately report 20690 with other surgeries. Previously, NCCI version 8.0 bundled 20690 with over 200 surgical codes, but now version 11.3 makes 20690 a component of 37 more surgical codes.
New way: You can no longer bill 20690 with several codes for capsulorrhaphy, arthrodesis, osteotomy, autograft, tumor resection, hand surgery, femur and knee surgery, and leg and ankle joint surgery. Count How Many Fixations the Surgeon Uses The American Academy of Orthopedic Surgeons (AAOS) says that you shouldn't bill for 20690 with codes whose descriptors say -with external fixation.-
In fact, -The AAOS has had 20690 listed as being inclusive to the arthrodesis codes for some time,- says Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J.
But you should be able to bill 20690 with codes whose descriptors say with -internal or external fixation---if you perform both internal and external fixation--because the code is only valued for one type of fixation. Be aware that the NCCI edits seem designed to make these code pairs more difficult.
-I don't think this will affect us too much,- says Denise Paige, CPC, coding and billing manager at Beach Orthopedic Associates in Long Beach, Calif. -Code 20690 describes application of a single-plane external fixator, which is usually applied at the time of the initial surgery, and in my practice external fixators are used more for comminuted tibia fractures than anything else, and I don't think I-ve ever seen an external fixator applied for a capsulorraphy.-
The code bundles do include -1- indicators, which means that you can use a modifier to separate the edits if necessary. -I would think if the code is bundled and the procedure is exceptionally difficult requiring an external fixator, a modifier along with a letter of explanation could possibly increase the reimbursement,- Paige says.