We have a patient who had a Halo placed on 7-27-14 for C2 fracture; we billed CPT 20661 (has 90 day global). Last week, patient felt a "pop" in the halo, and returned to our clinic today to have new pins applied. I know that the original application on 7-27 includes any adjustment done in the post-op period, and removal. But does the "adjustment" include adding new pins? If yes, there's nothing else to bill, this would be included in the global package. If no, would the same code be used--20661--with a modifer? The MD's PA wants to use 20690 (Uniplane External Fixation system), which I am not agreeing with. My thoughts are that this would be included in the global. Here is what is documented:

"The patient came in to have his new halo screws placed. We placed four new screws and we did not take out the old screws. We shaved and prepped the skin areas appropriately in the frontal and parietal regions bilaterally. We placed 4 screws and torqued them down until the pressure pins were approximately 2 mm protruded as they should be. The patient was not wearing his cervical collar today, I told him in no uncertain terms I want him to wear that 24/7 in addition to the halo to prevent any further weakening of the new or existing halo pins. He recognizes that noncompliance could lead to failure of the halo which would put us in a very difficult situation. We have been having issues with compliance in that the patient did not follow our instructions to go immediately to the ER when he contacted us telling us he felt the pop in the halo and he is not wearing a collar as directed. Instead he waited several days before having the halo evaluated. I assured him I'm not trying to be difficult however I'm trying to give the best and safest outcome possible. I will see him in one month with repeat x-rays."

Appreciate any guidance/resources anyone can offer!!