Wiki Billing 27758 and 27759 together?

[dhartnettsmith]

I have a physician who is trying to bill 27758: Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage and 27759: Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage.

The tibia is fractured in multiple spots so he performed a plate and screw fixation on one portion and then an intramedullary implant on the entire shaft. Wouldn't 27759 be appropriate since it is one bone or is it ok to use both codes since there were multiple fractures within the same bone?

Any advice is greatly appreciated.

thank you

 

[Orthocoderpgu]

You have to follow the "Golden Rule" the one who has the gold makes the rules. In this case, the insurance company which will not likely pay since the codes hit an edit and 27758 is bundled with 27759 which is a "more extensive" procedure. No doubt that both fractures were repaired through separate surgical approaches (incisions). And if the IM Nail does not "treat" the second fracture, you could bill it with a modifier, but I would not expect payment for it either. No doubt you will have to file an appeal. My experience has been that people reading the appeals at the insurance company really don't know what they are doing which is sad because I see docs putting in all this extra work that they deserve to get paid for and is "medically necessary" just to see someone at the insurance company deny them all because they aren't familiar with orthopedics.

 

[dhartnettsmith]

You have to follow the "Golden Rule" the one who has the gold makes the rules. In this case, the insurance company which will not likely pay since the codes hit an edit and 27758 is bundled with 27759 which is a "more extensive" procedure. No doubt that both fractures were repaired through separate surgical approaches (incisions). And if the IM Nail does not "treat" the second fracture, you could bill it with a modifier, but I would not expect payment for it either. No doubt you will have to file an appeal. My experience has been that people reading the appeals at the insurance company really don't know what they are doing which is sad because I see docs putting in all this extra work that they deserve to get paid for and is "medically necessary" just to see someone at the insurance company deny them all because they aren't familiar with orthopedics.

Thank you so much for your response! I was thinking the same thing but wasn't sure since I am new to Ortho.