Question: 20694 & 11044 being bundled?


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Our surgeon performed the following surgery including the removal of a previous fixation device (20694) and removal of mulitple loose bodies (11044) during the same operative session. These two codes are being considered inclusive with the primary procedures. Do you think these two codes should be reported separate? Or considered included?

These are the procedures billed by the surgeon:

27827 Open reduction/internal fixation tibial pilon fx, sep incision
27758 Open reduction/internal fixation right tibia, one incision
27766 Open reduction/internal fixation medial malleolus fracture, separate incision
27620 Arthrotomy ankle (bundled)
20694 Multiple loose body removal right ankle
11044 Removal of external fixator previously placed
I am no expert in ortho, but I do like a challenge.....
If you review 27620 -Arthrotomy, ankle, w/joint exploration, w or w/o bx, w or w/o removal of loose or foreign body. That last statement sums it up, you cannot charge for the "loose body removal" as the code includes it. Also, as far using 11044 - Debridement, skin, subcu tissue, muscle & bone; these debridement codes are not usually associated with fractures, usually used for infection of the skin that cause necrosis thru the layers, sometime down to the bone, etc... anyone can correct me if I am wrong, but it's not an appropriate use. With regards to 20694, it's questionable, I work ENT, when we have to replace pressurizing tubes in a patient's ears, we cannot charge for the removal of the old tubes; I know the comparison is extreme, but the principle is the same, hence the bundling; if you are removing the hardware only, you charge for it, if you are removing and replacing, you do not charge for the removal.

Hope this helps......

When I check the edits for the codes none of the codes you have listed show to be bundled. I do somewhat agree with the previous poster as I also question your use of 11044 for "removal of foriegn bodies" because that is a debridement of tissue CPT & because the arthrotomy 27620 includes removal of loose or foriegn bodies. Now if your physician did indeed debride skin, subcu tissue, muscle & bone then I would say it was ok to bill the 11044 or if this was an open fracture then you could go with 11012. I also see her logic regarding tube removal (as I also bill ENT so these are common) but there are times in orthopedics that removal of hardware external or internal is not considered bundled per the cci edits (your individual carriers though are another story). I would be happy to help you more with this if you could provide me with the op note so I could better understand what your physician did.