Orthopedic Coding Alert

Question: One surgeon from our practice performed an open reduction with internal fixation of a nonunion radius fracture, and removed some hardware. The other surgeon (also from our practice) did the iliac crest bone graft, but did not assist the first orthopedist. How should I code this?

Illinois Subscriber

Answer: This should be reported as a co-surgery, with each surgeon reporting 25405-62 (repair of nonunion or malunion, radius OR ulna; with autograft [includes obtaining graft]; two surgeons). You can also bill for the hardware removal, 20680-62 (removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]; two surgeons). The problem may be that carriers will request documentation questioning why this procedure was performed by co-surgeons, a situation that is usually reserved for complex surgical procedures, so there may be a struggle for reimbursement. An operative report, and perhaps a letter signed by both physicians indicating the unusual circumstances that led to the co-surgery should assist in reimbursement. But if the carrier has a system that automatically "kicks out" claims for co-surgery for this particular procedure, you will have to appeal the claim anyway.