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mutiple debridements

  1. #1
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    Question mutiple debridements
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    patient had crush injury of the left foot. dr. debrided 1st metatarsal fx ,1st metarsarsal phalangeal joint,1st prox phalanx fx 5th metatarsal fx , 5th tarsometatarsal joint and Lt. cuboid fx coded ea 11012 w/59 modifier all but one was denied. He states these were all opened fx and states he debrides to the bone in each. We didnt appeal because it was determined that only 1 incision was made so 4 of the debridements were void. Dr. felt he should have been paid for each since he felt alot of work went in to surgery. Any thoughts ?
    Ortho/coder

  2. #2
    Default
    Maybe the -22 could have been used instead along with the dr's documentation to back up all of the extra work?

  3. #3
    Default Agree with Leslie re: mod 22
    I agree with Leslie regarding the modifier 22. I would also state in your appeal cover letter how much additional time this took over and above what is normally expected with this procedure. I don't have the procedure notes in front of me, but based on what you are describing I would allow additional for the modifier 22 (I am a coding review nurse for a payer).
    ******************

    PB

  4. Default
    Quote Originally Posted by klestes View Post
    patient had crush injury of the left foot. dr. debrided 1st metatarsal fx ,1st metarsarsal phalangeal joint,1st prox phalanx fx 5th metatarsal fx , 5th tarsometatarsal joint and Lt. cuboid fx coded ea 11012 w/59 modifier all but one was denied. He states these were all opened fx and states he debrides to the bone in each. We didnt appeal because it was determined that only 1 incision was made so 4 of the debridements were void. Dr. felt he should have been paid for each since he felt alot of work went in to surgery. Any thoughts ?
    I would not even bother doing anything else with this one because since there was only 1 incision he shoud be happy with the ones he got paid for because this was all on LT foot, one incision, and for the description of that code it says associated with open fracture(s) so that code is for one or more fracture. If he made multiple incisions and shows they were all different fractures then by all means appeal, but I dont think you have a leg to stand on with this one.
    And if he did document extra work then you should have coded this as 11012-22, just once. Not for each.
    Hope that helps.

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