Wiki tibia fracture with lateral meniscus and LCL tear

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JYSPA

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hello,

Can I bill for all?

1. Open reduction and internal fixation of bicondylar tibial plateau fracture. CPT 27536
2. Open repair of lateral meniscus, including the body and anterior horn and the anterior root and intermeniscal ligament insertion. CPT 27403
3. Open repair of the lateral collateral ligament was suture repair only. CPT 27405
4. Removal of external fixator under anesthesia. CPT 20694

The tibia plateau fracture extends to shaft. Additional plate was put in at shaft for fracture - CPT 27758

CPT 27403 bundles with CPT 27405. Can I add modifier 59?

So, 27536, 27403-59, 27405, 20694, 27758 ?

Thanks in advance...
 
The only way to answer your question would be to read your op note. If 27405 and 27403 hit an edit, what is your reasoning for a -59? I'm not saying you can't just want to know what makes it qualify for a -59? Out of all the codes only 27405 & 27403 hit an edit.
 
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The report is 3 pages long.. I just want to know if 27405 and 27403 can be billed for same leg/same incision.
 
JYSPA said:
The report is 3 pages long.. I just want to know if 27405 and 27403 can be billed for same leg/same incision.
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If your going to be a coder, your going to need to be able to review this like a coder. The codes hit an edit which means that in order to bill both, your going to need to use a -59, but it has to QUALIFY for a -59 or it's bundled. As a coder your going to need to be able to identify when they bundle, and when they don't. Same leg/incision, doesn't s sound like this qualifies for a modifier -59. Keep in mind that this applies to all codes that hit an edit, not just these two.
 
If you are going to be a guru in orthopedic, I suggest you know what you are saying.. Knee has separate compartments and 59 modifier can be used even if it is same knee.. I suggest you learn ortho coding before answering in this column.
 
JYSPA said:
If you are going to be a guru in orthopedic, I suggest you know what you are saying.. Knee has separate compartments and 59 modifier can be used even if it is same knee.. I suggest you learn ortho coding before answering in this column.
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I meant to be a bit direct with you, but not offend you. That was not my intention. Just so you know my background. I have been coding orthopedic surgeries for the past eight years. I have been training other orthopedic surgery coders for the past two years. Orthopedic Coder III's routinely seek my advice on surgery coding. I have also helped coders all over the country in both orthopedics and other specialties through this forum as I have been coding since 2003. Getting back to your surgery, had these procedures been performed through separate incisions one medial and one lateral, they would qualify to be billed together. Since they were performed through the same surgical approach, they bundle. I'm well aware of the knee compartments. That does not come into play here.
 
Ok - not sure how this got so off the rails here. This is my perspective:
The original poster asked a question regarding modifier -59. The question was answered with the limited information provided and indicated there was some doubt and encouraged further discussion. The original poster then basically re-asked the same question without providing any further information or discussion. The person who originally answered went into further detail about -59 and explained not just for this surgery, but for all surgeries, -59 needs to have certain requirements that (again with limited info) "sounds like" it doesn't qualify for. The original poster then got rather insulting, and said -59 can be used (still not providing any further info).
If the original poster already knew all the rules as to whether or not -59 was met, then what was the question in the first place???

My personal opinion is that if a total stranger was willing to read my 3 page report and give their expert advice on their own time to help me with my job, I would post the 3 page report. And not get rude when they provided an answer to my original question.

There's my 2 cents that no one asked for. ;)
 
Orthocoderpgu said:
I meant to be a bit direct with you, but not offend you. That was not my intention. Just so you know my background. I have been coding orthopedic surgeries for the past eight years. I have been training other orthopedic surgery coders for the past two years. Orthopedic Coder III's routinely seek my advice on surgery coding. I have also helped coders all over the country in both orthopedics and other specialties through this forum as I have been coding since 2003. Getting back to your surgery, had these procedures been performed through separate incisions one medial and one lateral, they would qualify to be billed together. Since they were performed through the same surgical approach, they bundle. I'm well aware of the knee compartments. That does not come into play here.
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Orthocoderpgu, thanks for clarifying. I know the two codes hit an edit. Orthopedic coding is new to me (last 2 yrs) but I have been coding other specialties since 2007 (mostly neurosurgery but also derm, opthalmology, etc ), so I know how to use 59 modifier but every specialty is different. I just like to be very sure when I am adding 59 modifier or removing a physician's code when the codes hit an edit and wanted a second opinion as I said ortho is a little new to me. Also, thanks for answering to my question.
 
JYSPA said:
Orthocoderpgu, thanks for clarifying. I know the two codes hit an edit. Orthopedic coding is new to me (last 2 yrs) but I have been coding other specialties since 2007 (mostly neurosurgery but also derm, opthalmology, etc ), so I know how to use 59 modifier but every specialty is different. I just like to be very sure when I am adding 59 modifier or removing a physician's code when the codes hit an edit and wanted a second opinion as I said ortho is a little new to me. Also, thanks for answering to my question.
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The "compartment rule" comes into play with "Arthroscopic" procedures, not open. So when the codes hit an edit there has to be some sort of "separation" in order to bill both. That usually means a separate incision. I've been coding orthopedic surgeries for eight years so if you have a question just let me know or post it.
 
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