Orthopedic Coding Alert

Question: Our surgeon repaired a nonunion of a left intertrochanteric femur fracture (27470) and hardware removal (20680). The broken hardware actually caused the nonunion. The National Correct Coding Initiative lists 20680 as a component of 27470, but it indicates that we can report both codes if we use a modifier. What would Medicare consider an appropriate reason to append a modifier to 20680?

Ohio Subscriber
 
Answer: If the surgeon removed the hardware through the nonunion repair incision, your documentation probably does not support reporting both 27470 (Repair, nonunion or malunion, femur, distal to head and neck; without graft [e.g., compression technique]) and 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]). Most payers will argue that the surgeon couldn't have accessed the nonunion without first removing the hardware. 
 
But if the hardware actually broke away from the fracture site, and the surgeon created a separate incision to access it, Medicare should reimburse you for both services. For example, if two screws broke away from the fracture and a metal plate remained adhered to the bone, your surgeon probably spent more time than average removing the hardware. If that is the case, you should submit the operative report with your claim and append modifier -59 (Distinct procedural service) to 20680.