Wiki coding of an unsuccessful fracture reduction

[NEOSM507]

If a doctor performs an honest attempt at reducing a fracture, and it is unsuccessful, leading to the scheduling of ORIF, is the initial reduction billable? Would it require a modifier? I'm getting different information on the usage of modifier 52 in this scenario.

Thank you

 

[Swathi99]

don't confuse unsuccessful results after completed surgical procedures with aborted/discontinued procedures. A completed procedure is still considered a completed procedure, whether or not it results in the appropriate or expected therapeutic results. If this is the case, you shouldn't report the procedure with a -52, -73, or -74 modifier.

When a procedure is considered to have "failed," in that it was not successful in achieving the intended result or every objective of the procedure could not be carried out, the procedure is coded as performed..

 

[sxcoder1]

Agree and ORIF would have 58 modifier.

 

[RyanRaichCPC]

I agree with the use of -58. This can be a somewhat common occurrence.

 

[ACord]

-53 Modifier Suggestion

I would bill the initial procedure with a -53 modifier (Discontinued Procedure). The description states "Under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure." It further goes to describe that this modifier is to be used for started procedures that were discontinued due to non-elective reasons after the patient undergoes anesthesia. The doctor decides that he or she can not complete the procedure due to a medical reason, such as the patient undergoes a cardiac event or the fracture/dislocation is not able to be reduced. I often see hip dislocations post-THR where the surgeon is not able to reduce the dislocation in the ER despite 2-3 attempts and decides to admit and open up the hip and exchange the poly spacer for a different size because the femur will not stay in place. We bill the attempted reduction with a -53 modifer.

I also agree that the subsequent ORIF would take a -58 modifier.

The -52 modifier should be utilized to describe cases where the surgeon does not perform all of the parts of the procedure on purpose. We often use this one for total hip revisions where the patient has an acetabular shell or femoral stem that the surgeon decides can be left in place because it is stable, but the rest of the components are loose/failing and need replacement.

In either of these cases, you will most likely be asked for the medical documentation by the carrier as payment is up to their discretion.

 

[RyanRaichCPC]

Modifier -53 would not be appropriate in this situation. The procedure was not aborted, the fracture didn't reduce properly and another surgical procedure had to be performed in the global period.

 

[sxcoder1]

I agree that modifier 53 would not be appropriate.

 

[MI_CODER]

I would code the above scenario as unsuccessful attempt -52 and ORIF next day -58.

The reduced-services modifier is appropriate because the complete procedure as described in CPT was not carried out. Use -52 for Closed,Then Open Reductions Suppose a patient has a hip dislocation and reports to your orthopedic practice. The orthopedist attempts a closed reduction, hoping to forego surgery for the more conservative treatment. The closed reduction fails, however, and the patient requires an open reduction the next day by the same physician. Can the practice bill for both services? The right to receive reimbursement for a procedure does not rely on its success or failure, so both attempts can be billed, says Donna Watkins, billing coordinator at Hiler Sports Medicine, a two-orthopedist practice outside of Washington, D.C. Because the closed treatment failed, the practice should bill 27250 (Closed treatment of hip dislocation, traumatic; without anesthesia) appended with modifier -52.

The next day, the practice would bill 27253 (Open treatment of hip dislocation, traumatic, without internal fixation) with modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) appended to indicate that the open procedure was related to the closed procedure but that the global period should be effectively "reset" because the closed reduction failed.

https://www.supercoder.com/coding-n...-use-modifier-52-for-reduced-services-article