painful hardware

solocoder

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Could I get some opinions on this surgery please?
Dr. removes painful hardware AND exostoses in the same area. Yes, the hardware has to be removed in order to perform the excisions, so normally it would be included, correct? BUT in this case the painful hardware is the patient's main problem/primary dx. There are no NCCI or CPT bundling issues. Is there any reason I couldn't bill them all?
 

Orthocoderpgu

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If there is no bundling issue, I would say go for it. You have two procedures and two separate diagnosis codes. Put -51 on the second procedure. Docs get ripped off by insurance all the time, so any time there is not a bundling issue and you have a separate diagnosis; go for it.
 

PLAIDMAN

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Could I get some opinions on this surgery please?
Dr. removes painful hardware AND exostoses in the same area. Yes, the hardware has to be removed in order to perform the excisions, so normally it would be included, correct? BUT in this case the painful hardware is the patient's main problem/primary dx. There are no NCCI or CPT bundling issues. Is there any reason I couldn't bill them all?

your hardware removal codes 20670 ; 20680 are listed as "separate" procedures , you cannot bill together same time/same body part
 

AlanPechacek

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Unfortunately, there is not enough information provided to give this a clear answer, i.e. what type to fixation, from where was it removed, how long it had been there, and such. Also, were the "Exostoses" removed associated with the fixation device itself and part of the pain problem for which the fixation was removed, or were they just in the same general area and felt to be symptomatic, but not related to the fixation?

If the fixation had been present for some time, then sometimes a boney reaction to the fixation causes "exostoses" around or even over the fixation such that removing the "exostoses" would be an integral part of the fixation removal, and hence would be part of/included in the 20670 or 20680, possibly with Modifier 22.

If the "exostoses" were felt to be a separate problem, i.e. an additional source of pain, but "in the neighborhood" of the fixation, then the removal of them would be a separate procedure, and could probably be charged separately with Modifier 51. You will need to read the operative report verycarefully to sort this out, or discuss it with the surgeon.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com
 
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