Wiki Closed fracture reduction followed by ORIF next day.

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stacy

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I'm looking for any supportive information/guidelines to code for closed reduction of a fracture one day then followed by ORIF the next day. It was a planned surgery. I believe this can be done as it was planned and performed on separate days. NCCI informs but I fill this is for the same day as a manipulation of a fracture can be done and not hold in place to follow with ORIF in same day. Any thoughts would be helpful.

From NCCI Manual:

15. When a fracture or dislocation is repaired, only one fracture/dislocation repair code may be reported. Closed repair codes, percutaneous repair codes, and open repair codes for the same anatomic site are mutually exclusive of one another, and only one of these codes may be reported for the repair of a fracture or dislocation at an anatomic site.
 
Commercial insurance is primary along with using codes 25605 then next day 25609. I would agree to use modifier 58. Is there any coding guidelines to show for coding this way? I need supportive information to show and I'm not able to locate any information.
 
Agree. This is a very common scenario in trauma, for example. The patient comes in with a severely displaced distal radius fracture, the PA reduces and a splint is applied. Then, in the next day or so the ORIF is performed. If it's an open fracture sometimes they have to wait for the swelling to go down, this would be more common in LE fractures though. The provider should still get credit for the reduction and you use the 58 as stated above for the planned ORIF during the global of the closed tx.
 
I have the same situation but the open w/internal fixation was done on the same day by the MD. The closed reduction was done in the ER by the PA who worked for the same ortho department.
 
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