Wiki Radius/ulna shaft fx

[blondedixie]

Please help. I need advice on what would be best way to report the followng:
Pt had radius/ulna shaft fx, md tried closed reduction w/manipulation on radius and ulna, reduction on radius failed but ulna fx treatment was successful. Md had to switch to an orif to treat radius shaft fx. What is best way to report this. Was billed originally w/25515 and 25535. Ins has denied the 25535.

 

[bwoolard]

Were the open and closed reductions performed in the same operative session?

 

[blondedixie]

Yes they were

 

[CodingKing]

Per NCCI Manual:

10. If a closed reduction procedure fails and is converted to an open reduction procedure at the same patient encounter, only the more extensive open reduction procedure is reportable. Similarly, if a closed fracture treatment procedure fails and is converted to an open fracture treatment procedure at the same patient encounter, only the more extensive open fracture treatment procedure is reportable.

I think 25574 might be a better option

 

[blondedixie]

Thank you very much!!!!!