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27822 and 27842

Tammy Posted Mon 04th of April, 2016 12:43:00 PM

I have a physician wanting to bill 27822 Left ORIF Trimalleolar Ankle Fx and 27842-51 Left Treat Ankle Dislocation. I do not see that there is bundling of these two code but I any getting a denial from insurance saying it is bundled. Is it bundled and if so where is the proof?

SuperCoder Answered Tue 05th of April, 2016 03:15:17 AM

As per NCCI (National Correct Coding Initiative)2016,If a closed reduction procedure fails and is converted to an open reduction procedure at the same patient encounter, only the more extensive open reduction procedure is reportable. Similarly, if a closed fracture treatment procedure fails and is converted to an open fracture treatment procedure at the same patient encounter, only the more extensive open fracture treatment procedure is reportable.

Closed treatment of ankle dislocation was followed by open treatment of ankle fracture in the same session. In this cases as per NCCI policy, only the open procedure is reimbursable.

Reference NCCI-Policy-Manual from CMS website

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