Wiki Need help with a coding question

[swilson21]

My physicians and I are disagreeing with the way this surgery should be coded.
The procedure is an ORIF of the midshaft radius and ulna. I have 2 physicians as co-surgeons. One physician performed the reduction and fixation on the radius and one physician performed the reduction and fixation on the ulna. Each as co-surgeon for the other.
Any opinions as to how this should be coded?
25575-62
25575-62
or
25515-62
25515-62
25545-62
25545-62
I would appreciate any help.
Thanks!

 

[maryalicecollins@gmail.co]

From the payer perspective, I would question the mod -62. You will have to supply medical necessity for the co-surgeon on those CPT codes. Assistant surgeon is allowed however.

 

[swilson21]

I have verified the use of the 62 modifier I was just questioning the proper coding of the procedure.
Thanks!

 

[OCD_coder]

The combo ORIF code better describes what is performed when you have both a radius and ulna fracture. The separate codes should be billed when only a single bone is reduced ORIF. Without looking at the note, I would support only the 25575-62.

CPT Description:
When both the radius and ulna are fractured, the physician exposes and reduces both fractures prior to fixation. Separate incisions along the forearm may be needed to expose the fracture. In 25574, only one fracture is stabilized, requiring only one incision. The other fracture is stable and does not require fixation. In 25575, both radial and ulnar fractures require fixation, usually requiring separate incisions. Once the fracture site is exposed and reduced, internal fixation is applied. A plate of appropriate length is selected and centered over the fracture. The physician inserts the screws. The incisions are repaired in layers with sutures, staples, and/or Steri-strips. The deep fascia is not closed, preventing the development of compartment syndrome. Depending upon the rigidity of the fixation, a cast or splint may be applied.