Question External Fixator Distraction

wgore18

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For certain tibia pilon or tibia plateau fracture presentations, my providers will utilize a uniplane external fixator to distract the knee or ankle joint so that the fracture can be visualized and repaired. The fixator is removed at the end of the same surgery. Some of my providers will attach a 20690 [application of external fixator, uniplane] on the charges for the operation in addition to the open fracture treatment. Has anyone found any documentation as to whether an ex fix can be billed when used in this way? To me, this seems like a more advanced version of the "separate procedure" status code (20650: application of pin with skeletal traction, including removal). However, I know that an external fixator is considered a different type of treatment than skeletal traction.

Thank you for reading!
-Wesley
 

Orthocoderpgu

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That's an interesting take. I'll give you my two cents worth of information since I don't have anything on paper that would back this up. After coding orthopedic surgeries for several years you see that "distraction" is just a part of many procedures. So I personally don't see it separately coded here. One of the surgeon's in our clinic is a highly sought after foot & ankle specialist who I coded for for over three years. If he put on an external fixator it's because he needed to wait for the swelling to go down before he could operate. And I think that's the intent of the code. Otherwise it just seems it would be included in performing the procedure. ** Congratulations on getting your COSC while still being a CPC-A. That is not easy. I have never attempted to sit for the COSC since it has so much spine surgery, which is the only specialty that I have not coded.
 

wgore18

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Well, I appreciate your insight with or without documentation since general coder judgement might be the only support I'll find for advising my providers on when to charge for external fixators. **Thank you! I wanted to get certified quickly so that my providers could feel the coding and information I provided them was sound. Spine surgery is also not done with our provider group (and only a few types of foot procedures), but the COSC study guide and practice questions at least prepared me to do decently well for those sections.
 

fwnewbie

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What you describe is the equivalent of a retention device used to effect the procedure and then is removed. I doubt it is a chargeable procedure in this situation.
 
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