Wiki conflicting coding rules!!!!

[abright609]

my surgeon wants me to bill the following:

25609- open treatment of distal radial intra-articular fracture; with internal fixation of 3 or more fragments

with

20690- application of a uniplane unilateral, external fixation system

I've used 3 resources that tell me that these codes are inclusive of each other and I can not bill for them together. My surgeon is insisting that I can. Has anyone used these codes together (without a modifier 59)?

your help would be GREATLY appreciated!

Thanks!
Amy

 

[mack80]

Hi Amy -

My research shows that 20690 is a subset to 25609, but that's not a CCI edit. This is an external editing system and I think it's because the procedure 25609 includes immobilization in a cast (per the Coders Desk Reference), which would make the external fixation system redundant. I think you will need to append modifier 59 to 20690 and modifier 52 to 25609 and submit the operative report. Point out that there was no cast (modifier 52 - reduced services) , but the external fixation instead. It may end up being reviewed by a Medical Director for the insurance company.

No guarantees this will work, but it's worth a try.

Thanks,
Marcia

 

[ivonneatanacio]

According to CCI edits you can bill these codes and they are not considered inclusive, But do append 59 on 20690.


Hope this helps.