Orthopedic Coding Alert

Question: One of my physicians started to do a repair of a talar dome fracture through the arthroscope. He was unable to get a reduction so he had to convert to an open procedure and perform an arthrotomy. I am coding for both the arthroscope and the arthrotomy. Should I use the -53 modifier on the arthroscopic code and then code the arthrotomy (there is no fracture care code for a talar dome fracture) with a -59 modifier? Or should I code both procedures without modifiers and send the operative report with a letter of explanation?

Christie Beach, CPC
Comprehensive Orthopedics, Kenosha, Wis.

Answer: This scenario comes up frequently in arthroscopic surgery. There are two appropriate ways to submit the claim:

1. Code the arthroscopy (29892, arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation [includes arthroscopy]) with a -53 modifier (discontinued procedure), and the arthrotomy (28445, open treatment of talus fracture, with or without internal or external fixation) with a -59 modifier (distinct procedural service) and send both the operative note and letter explaining the circumstances; or

2. Do not code the arthroscopy, but append modifier -22 for unusual procedural services to 28445 and send both the operative note and clarifying letter. In a gray area like this, it is a good idea to call the carrier and see how it would recommend you code the procedures.