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P Posted Mon 04th of December, 2017 16:18:43 PM
On 11/03, doctor did • 25605, closed reduction of left distal radius • 26750 x 2: close treatment without manipulation for right ring and small fingers 29085-22 for the left arm. On 11/17, patient came back for follow up. Patient is alert and oriented and ambulating independently. The left short arm cast is in good position and is clean. The patient moves her fingers well without difficulty and there is no significant swelling and sensation is intact with good capillary refill. Elbow is non-irritable. The right hand is examined out of the splint. There is definite deformity of the ring finger with what appears to be shortening and extension deformity at the proximal phalanx. There are Heberden's nodes and obvious arthritic changes throughout the hand. Clinically the little finger appears to be well aligned and not her finger shows any rotational deformity. Diagnostic Studies AP and lateral and oblique of the right hand reveals the patient have significant extension deformity of the proximal phalanx at the ring finger due to displacement of the fracture which is at the base of the proximal phalanx and close to the joint but not extending into the joint. There is also some extension deformity of the similar fracture at the little finger but I am not as concerned about the alignment. AP and lateral of the wrist through the cast reveals some mild shortening of the distal radius but good overall alignment and certainly acceptable alignment. Impression #1. Status post left Colles' fracture with the patient doing well in the molded short arm cast. #2. Fractures of the proximal phalanx of both ring finger and little finger with extension deformity that is unacceptable at the right ring finger. Plan/Recommendation The patient will continue in the left short arm cast. Regarding the right hand I do recommend manipulation of the ring finger and a claw cast to better immobilize the LaMar 2 digits. The patient does understand and consent. The right ring finger is treated by prepping with Betadine and anesthetizing with ethyl chloride and then injecting the fracture with plain 0.5% Xylocaine with a total of about 3 cc injected. This is injected directly into the fracture site with excellent anesthetic effect. The digit is then manipulated by placing extension and correcting the extension deformity. The little and long fingers are then immobilized in a claw cast with flexion at the MP ioint. Post cast films reveal definite improvement and acceptable Doctor bill <99214 (S62.614D, S62.646D)>, <73130, 73130-76, 26725 (S62.614D)>, 29085 (S62.646D)>. I think the second visit is post-op, and we can only charge 73130, 73130-76 and 29085. Am I right?
SuperCoder Answered Tue 05th of December, 2017 04:48:49 AM

As per the presented documentation, X-rays were performed on hand and wrist, so the appropriate codes would be:

For AP and lateral X-ray of the wrist, use CPT code 73100

For AP and lateral and oblique X-ray of the right hand, use CPT code 73130

For claw cast application on little and long fingers, use CPT code 29085

P Posted Tue 05th of December, 2017 11:39:56 AM
What about 26725? Is this a post-op, or I can use 26725-58?
P Posted Tue 05th of December, 2017 17:03:37 PM
Do I need to add MOD -58 for 29085 since 29085-22 was used on the previous visit.
SuperCoder Answered Wed 06th of December, 2017 07:52:05 AM

Append modifier-78 with CPT code 26725 and to rule out the CCI edit between (26725 and 29085), append modifier-59 with CPT code 29085.

P Posted Wed 06th of December, 2017 14:17:47 PM
Can I have a different coder review my documentation? Your answer is wrong. Pt. had 26750 for the right ring finger on 11/03; The 26725 was performed on his second follow-up visit at office. How can you use -78 for a close treatment performed in the office. I don't pay for wrong answer. I'll need my money back if I don't receive a correct answer.
SuperCoder Answered Thu 07th of December, 2017 05:37:22 AM

In the above documentation, the place of service of the earlier procedure(s) for 11/03 and 11/17 was not mentioned so we provided you the information basis the procedure was performed in the operating /procedure room of the facility for which usage modifier-78 was appropriate.

Now, as per your documentation, the procedure was performed in the office, so you are advised to use modifier-58 along with CPT code 26725, as the usage of modifier-78 would not be appropriate in office setting.

 

Hope it helps! If you still have any query around the same, do let us know.

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