Does a Periprosthetic Fracture Treatment Need Modifier 22?
Question: I’m new to orthopedic coding and I’m looking for a second opinion on the following procedure: The femoral implant appeared to be well fixed to the distal femoral fragment. There was a separate fracture of the lateral condyle, which was a shell type piece which was easily lifted but was greater than 5 cm in diameter, was kept in place at this time. Attention was turned first to the supracondylar fracture of the femur just above the femoral prosthesis given the prosthesis had good fit. After assessment, this fracture line was first reduced and plated using a 2.7 mini frag plate. The lateral condyle fracture was then keyed in place and fixed separately with a K-wire at this time and advanced through to the medial side. The femoral shaft fracture was then lined up with block using a crab claw and the appropriate size plate was placed laterally to hold the femoral shaft fracture fragment in place. At this time, the screws were placed appropriately and in a combination of both cortical and locking screws. Does the work on the lateral condyle and the shaft described above warrant appending modifier 22 to 27513? California Subscriber Answer: You can make the argument for appending modifier 22 (Increased procedural services) to 27513 (Open treatment of femoral supracondylar or transcondylar fracture with intercondylar extension, includes internal fixation, when performed) because the surgeon treated a periprosthetic fracture. However, the operative note you’ve provided doesn’t describe additional difficulty. Most supracondylar fractures are bicolumnar and require reduction and fixation of both condyles. Therefore, you should only assign 27513 for the procedure. A periprosthetic fracture is a break in the bone around an orthopedic implant. In this case, the patient experienced a lateral condyle fracture, a supracondylar fracture, and a femoral shaft fracture around a femoral implant. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
