AAOS - Orthopedics question 27580

mindyanna

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Hi,

I need some opinions and or assistance on this scenerio I'm about to give. Our doctor did a knee fusion (27580) and used a temporary external fixator to assist in stabilizing the bones while they reamed the bone for the fusion rod. In the AAOS book it states that Internal or External fixation is considered bundled into the fusion code. The way I'm interpretting this is that you would not be able to bill any additional internal fixation or external fixation when using the fusion code. I have other coders who think that it means either or but not both. You can't bill for an ex-fix you will be taking off at the end of the case but the situation is whether to use a modifier 22 with the fusion code to represent the additional time and so on. My concern is that if I'm interpretting the AAOS book correctly then it would be wrong to bill out the additional time it took to use something that would be considered bundled anyway. Your thoughts are greatly appreicated! Thanks
 
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Hi Mindyanna...
CPT's descriptor states Arthrodesis, knee, any technique.... I would consider this inclusive.
 

bugu32

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You are correct a 22 modifier by definition is when the work require to provide a service is substantially greater than typically.The documentation must support additional amount of work i.e extensive debridement that took in excessive of 20-30mins or if the fusion was more difficult then usual because of weight ,which still must be documented by your physician he must indicated in the op note that something was unusual in nature.This is the only way you will even have a chance of getting it paid at a higher level.
The documentation is always going to be your best indication if something warrants a 22 modifier because if the physician did not think it was more extensive enough to note then you cant assume that it was.
 

mindyanna

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Thanks Patricia and Bug. I think it should be considered bundled and not bill for the mod 22 either. My doc does document quite a bit and normally the patient is obese and warrants the mod 22 but in this particular case the patient is not obese and I don't feel like it's right to bill for the xtra time it took to use an ex-fix when that ex-fix is considered bundled in the first place. Any other opinions are welcome too!
 
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