Orthopedic Coding Alert

Question: Our surgeon did an open treatment of femoral shaft fracture with screw insertion, 27506 (Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws). The screw came loose and the surgeon had to remove and replace the screw. We billed this with an unlisted code, 27599 (Unlisted procedure, femur or knee) and 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]) but the insurance denied since we did 27506 on the contralateral leg in the same session. Since unlisted procedure codes do not carry modifiers this is considered an inclusive procedure. Can you please elaborate on this and help us understand the reason for denial?

Maryland Subscriber

Answer: There is no code that describes removal and replacement of the distal locking screw. So you are correct in reporting unlisted code 27599. You need to confirm if you did append modifier LT and RT to communicate that codes 27506 and 27599 were performed on opposite legs. You may consider sending a letter appealing the claim denial on the basis that the procedures were performed on opposite extremities.