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Cheryl Posted Mon 15th of January, 2018 11:22:09 AM
My doctor did and ORIF distal radius extra articular (25607) for fracture and he also did a closed reduction percutaneous pinning of the scapholunate for scapholunate insufficiency. Can I code the second procedure? If so, what code would be best.
SuperCoder Answered Tue 16th of January, 2018 03:49:54 AM

When there is displaced fracture of distal radius, then there are maximum chances of wrist deformity. It seems that scapholunate insufficiency is a complication/result of distal radial fracture, this procedure is not included in the primary procedure (Radial ORIF) but may be denied when billed separately because the complication (scapholunate insufficiency) has to be fixed when physician is performing ORIF of distal radial fracture.

 

Percutaneous skeletal fixation describes fracture treatment which is neither open nor closed. In your procedure, the fracture fragments are may not be visualized, but fixation (eg, pins) is placed across the scapholunate site, hence physician had performed the extra work than the basis procedure (ORIF), so modifier 22 (Increased Services) can be append with the ORIF procedure for the additional payment for extra work.

 

In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:

 

–Increased intensity

 

–Additional time

 

–Technical difficulty

 

–Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician.

 

 

CMS guidelines stipulate that you should apply modifier 22 to indicate an increment of work infrequently encountered with a particular procedure and not described by another code. Situations that might call for modifier 22 include (but are not limited to):  – excessive blood loss – presence of excessively large surgical specimen (especially in abdominal surgery) – trauma extensive enough to complicate the particular procedure and not billed as additional procedure codes (as in your case).

Also, do not forget to attach op-report to the insurance in order to justify physician’s extra efforts.

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