Jazmina10
New
- Messages
- 7
- Location
- Kingman, AZ
I am getting questioned and actually pressured to give the provider the codes he wants and especially code 20680 which I have always found to be bundled in this situation. He is stating that since this patients had pain for 12 years the plate removal is medically necessary to remove which makes it payable, I agree but it still comes down to bundling as I know it. I know this is a doozy but I really need the ortho community's help to justify adding this code since it is bundled. Here is the op note:
Indication: The patient has a history 12 years ago of a right wrist dislocation from trauma which was treated with a dorsal plate wrist arthrodesis. It never actually took and he has motion that is painful at the right wrist. He also has signs and symptoms of cubital and carpal tunnel syndrome with no signs or symptoms of radiculopathy on the right upper extremity. He has no signs or symptoms of infection in the right wrist. I offered him elective removal of the hardware with tenolysis of the extensor tendons and a posterior interosseous sensory nerve to the wrist joint branch neurectomy and revision arthrodesis along with carpal and cubital tunnel releases.
Medial elbow was approached and the ulnar nerve was released in situ and the elbow brought to range of motion and the nerve noted to not sublux out of the groove. Attention was redirected to the right volar carpal tunnel region where a standard carpal tunnel incision was made and the transverse carpal ligament was released and no space-occupying lesions were noted and prior to releasing the nerve there were no transligamentous branches of the median nerve noted in the transverse carpal ligament. Attention was redirected to the dorsal wrist where the previous incision for the wrist fusion was made and the plate was then removed. The extensor digitorum communis was noted to be adhered to the plate over that dorsal hand and therefore dorsal extensor commonness tenolysis was performed and the extensor pollicis longus and extensor pollicis brevis were also identified noted to be intact. After the plate was removed a rongeur was used to smooth the bone. The posterior interosseous nerve sensory branch to that the carpus was identified and excised. The dorsal carpus was entered and the previous narcotic bone at the pseudoarthrosis was removed using a bur and rongeur. Using healthy bone of his own that had been harvested along with demineralized bone matrix and crushed cancellous bone chips, these were packed into the void that had been x-rayed and no other pseudoarthrosis were identified. These were packed into the joint and then a neutral Acumed dorsal wrist fusion plate was applied to the middle finger metacarpal and with compression slight dorsiflexion of the wrist the screw holes were drilled and filled using locking technology wherever possible and 3 view x-rays of the wrist flatplate's were taken before breaking sterility.
If my coding is incorrect, I'm ok with that, I just need to know because I get audited yearly and I want to either stand my ground or feel comfortable with changing my codes to satisfy my providers request.
I have coded this as 25800, 26449, 64718, 64721 - Provider wants 64708, 26449, 25800, 20680, 64718, 64721
Thank you so much for any and all assistance/
Indication: The patient has a history 12 years ago of a right wrist dislocation from trauma which was treated with a dorsal plate wrist arthrodesis. It never actually took and he has motion that is painful at the right wrist. He also has signs and symptoms of cubital and carpal tunnel syndrome with no signs or symptoms of radiculopathy on the right upper extremity. He has no signs or symptoms of infection in the right wrist. I offered him elective removal of the hardware with tenolysis of the extensor tendons and a posterior interosseous sensory nerve to the wrist joint branch neurectomy and revision arthrodesis along with carpal and cubital tunnel releases.
Medial elbow was approached and the ulnar nerve was released in situ and the elbow brought to range of motion and the nerve noted to not sublux out of the groove. Attention was redirected to the right volar carpal tunnel region where a standard carpal tunnel incision was made and the transverse carpal ligament was released and no space-occupying lesions were noted and prior to releasing the nerve there were no transligamentous branches of the median nerve noted in the transverse carpal ligament. Attention was redirected to the dorsal wrist where the previous incision for the wrist fusion was made and the plate was then removed. The extensor digitorum communis was noted to be adhered to the plate over that dorsal hand and therefore dorsal extensor commonness tenolysis was performed and the extensor pollicis longus and extensor pollicis brevis were also identified noted to be intact. After the plate was removed a rongeur was used to smooth the bone. The posterior interosseous nerve sensory branch to that the carpus was identified and excised. The dorsal carpus was entered and the previous narcotic bone at the pseudoarthrosis was removed using a bur and rongeur. Using healthy bone of his own that had been harvested along with demineralized bone matrix and crushed cancellous bone chips, these were packed into the void that had been x-rayed and no other pseudoarthrosis were identified. These were packed into the joint and then a neutral Acumed dorsal wrist fusion plate was applied to the middle finger metacarpal and with compression slight dorsiflexion of the wrist the screw holes were drilled and filled using locking technology wherever possible and 3 view x-rays of the wrist flatplate's were taken before breaking sterility.
If my coding is incorrect, I'm ok with that, I just need to know because I get audited yearly and I want to either stand my ground or feel comfortable with changing my codes to satisfy my providers request.
I have coded this as 25800, 26449, 64718, 64721 - Provider wants 64708, 26449, 25800, 20680, 64718, 64721
Thank you so much for any and all assistance/