jvanek82
True Blue
- Messages
- 875
- Location
- Mims, Florida
Good afternoon!!
I have a provider who did an ORIF of distal radial fracture, 25609. During the surgery, he applied an external fixation device, 20692 to reduce the radiocarpal subluxation during the surgery and then removed the device at the end of the procedure, 20692. He wants to bill for the fixation device application and removal as well as the ORIF. We have advised that the traction is not separately billable, however he insists that he can bill since it was not for the radius fracture.
OP Note:
The procedure began with a small incision at the radial border of the radial diaphysis. Through this incision, a drill guide was placed on the cortex itself and through this, a 3 mm external fixator half pin was drilled for and placed in a bicortical fashion. This was followed by a similar procedure at the radial base of the 2nd metacarpal in which again a 3 mm external fixator half pin was drilled for and then placed through in a separate plane through both cortices of the 2nd and 3rd metacarpal bases. Every effort was taken to avoid injury to neurovascular structures. Both pins were connected to each other via a carbon fiber rod and custom distractor and distraction was accomplished, which reduced the radiocarpal subluxation and helped to reduce the distal radius fracture itself.
Attention was then turned to the volar and distal forearm. A longitudinal incision was make overlying the flexor carpi radialis tendon. The ceiling of the sheath was incised in line with the incision, the tendon was retracted radially, and the floor of the sheath was similarly incised. This gave access to the pronator quadratus, which was released from its radial attachment and reflected ulnarly. This then gave access to the fracture itself, which was cleaned of all soft tissue, hematoma, and other debris and reduced with a combination of dental picks. Freer elevators, and provisional K-wires to aid in reduction. Then, a distal radius volar locking plate was applied, and several locking and nonlocking screws were placed on either side of the fracture. K-wires were then removed, as was the external fixator, and final fluoroscopic imaging confirmed an adequate reduction and hardware placement. Wounds were thoroughly irrigated and closed in layers approximating skin. Then the ulnar styloid was addressed. With a slight reduction maneuver, it was reduced quite nicely and did not need further treatment. Soft dressings were applied, followed by a post-operative brace. The patient was awakened from general endotracheal anesthesia and taken to the recovery room in stable condition.
Can I get some help on the rules for this? Are these charges or are they not billable with the ORIF and can you provide me with a written source to support the information?
Thanks!
I have a provider who did an ORIF of distal radial fracture, 25609. During the surgery, he applied an external fixation device, 20692 to reduce the radiocarpal subluxation during the surgery and then removed the device at the end of the procedure, 20692. He wants to bill for the fixation device application and removal as well as the ORIF. We have advised that the traction is not separately billable, however he insists that he can bill since it was not for the radius fracture.
OP Note:
The procedure began with a small incision at the radial border of the radial diaphysis. Through this incision, a drill guide was placed on the cortex itself and through this, a 3 mm external fixator half pin was drilled for and placed in a bicortical fashion. This was followed by a similar procedure at the radial base of the 2nd metacarpal in which again a 3 mm external fixator half pin was drilled for and then placed through in a separate plane through both cortices of the 2nd and 3rd metacarpal bases. Every effort was taken to avoid injury to neurovascular structures. Both pins were connected to each other via a carbon fiber rod and custom distractor and distraction was accomplished, which reduced the radiocarpal subluxation and helped to reduce the distal radius fracture itself.
Attention was then turned to the volar and distal forearm. A longitudinal incision was make overlying the flexor carpi radialis tendon. The ceiling of the sheath was incised in line with the incision, the tendon was retracted radially, and the floor of the sheath was similarly incised. This gave access to the pronator quadratus, which was released from its radial attachment and reflected ulnarly. This then gave access to the fracture itself, which was cleaned of all soft tissue, hematoma, and other debris and reduced with a combination of dental picks. Freer elevators, and provisional K-wires to aid in reduction. Then, a distal radius volar locking plate was applied, and several locking and nonlocking screws were placed on either side of the fracture. K-wires were then removed, as was the external fixator, and final fluoroscopic imaging confirmed an adequate reduction and hardware placement. Wounds were thoroughly irrigated and closed in layers approximating skin. Then the ulnar styloid was addressed. With a slight reduction maneuver, it was reduced quite nicely and did not need further treatment. Soft dressings were applied, followed by a post-operative brace. The patient was awakened from general endotracheal anesthesia and taken to the recovery room in stable condition.
Can I get some help on the rules for this? Are these charges or are they not billable with the ORIF and can you provide me with a written source to support the information?
Thanks!