Wiki NCCI edit BKA amputation 27880 and Ex fix 20690 f/Femur fx

[cmacpc]

Good Morning:

I need some help on this one, I have a case where the Ortho provider did a case on a patient. 27880 Amputation at the BKA Traumatic amputation for fracture at TIB/FIB then he applied an Ex fix 20690 on the Femur for an open Fx , and did and Debridement to bone 11012. I put the codes thru Encoder and since 27880 has the higher RVU i have to attach modifier 59 to that code so it would look like this:

27880-59
20690
11012

Yes it is on the same extremity Left side.

any ideas or opinions are appreciated.

Thank you

 

[iowagirl77]

Was the debridement done at the same site as the amputation? If so, it is included and you should not bill the 11012.

 

[cmacpc]

Debridement was performed at Fracture site

Thank you.

 

[cmacpc]

any takers on this question???

 

[cgaston]

I'll give it a go! (without having a report I am only guessing on the type of repair done) but I'd choose 27507 for the femur fracture (the debridement is included and there is no NCCI edit with 27880).