Orthopedic Coding Alert

Question: I am having difficulty coding for removal of an intramedullary rod from a patients femur. In one case, it took the physician three hours to perform the procedure. Code 20680 does not provide much in the way of compensation for the complexity of this procedure. Is there another way to get additional compensation for the work involved?

J. Greenwald, Western Orthopedics

Answer: The correct CPT code for the removal of an intramedullary rod from a femur is 20680 (removal of implant, deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]), says Catherine Brink, CMM, CPC, president of Healthcare Resource Management in Spring Lake, N.J. But she adds that the -22 modifier (unusual procedural services) can be appended to 20680 to tell the payer the procedure was more complicated than usual.

Brink says to include a copy of the operative note, a must when using the -22 modifier, and to increase the charge for the procedure to reflect it is more complicated than normal and took more time. She advises that an appeal process is in order if there is a denial or a payment that does not reimburse for the more complicated procedure.