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billing tenotomy with wrist 3-part fracture care

  1. #1
    Location
    Columbus, Ohio
    Posts
    105
    Post billing tenotomy with wrist 3-part fracture care
    Medical Coding Books
    I'm needing some input on billing a tentomy with wrist fracture code 25609. All three of the surgeons often do a tentomy of the brachioradialis tendon along with the fracture reduction. I use the 25290 tenotomy code and when I run code check, I do not get any coding edits. BWC is denying the 25290 and our collection specialist thinks maybe they shouldn't be billed together unless there is a separate diagnosis. Should they not be billed together? Any ideas, feedback, etc. Once again, I appreciate all the help I get from this forum. Paula in Dublin, Ohio

  2. #2
    Default
    You're right! These 2 procedure are not bundled, in my opinion.
    I think you should try a seperate dx, a fracture dx would not cross-reference with a tenotomy code?

  3. #3
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Per the AAOS Global data guide,(I believe this is the resource...I do not have this but posed a similiar question to Margie Vaught not long ago), the tenotomy is included HOWEVER if they are doing a lenghthening with REPAIR, it would be separately reportable.

    Keep in mind that not all edits come from CCI

    If someone has the AAOS global guide and can verify this, that would be awesome, I will also see what I can find.

    Hope this helps
    Mary, CPC, CANPC, COSC

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    This is an e-mail I found:

    "This question was ask about 25609 and brachioradialis release and Kristi was able to get the following from ASSH which is just what we needed..


    25609

    I would like to remind our members that when performing an open reduction and internal fixation of a three-part or greater distal radius fracture (25609) the release of the brachioradialis is considered an integral part of the procedure and is not separately billable.



    Margie Scalley Vaught, CPC, CPC-H, CCS-P, MCS-P, ACS-EM, ACS-OR
    Healthcare Consultant
    Coding Content Specialist for DecisionHealth
    scalley123@aol.com
    cell 360-880-8304
    fax 413-674-7668
    www.margievaught.com
    for workshops and audio http://www.margievaught.com/calendar/index.cfm
    Advanced Ortho Symposium Sept 14-16th 2009 - Come learn about everything Ortho related from front office, appeals, office procedures to surgical procedures shoulders - toes and spine http://www.decisionhealth.com/ortho2009/"
    Last edited by mbort; 08-07-2009 at 02:37 PM.
    Mary, CPC, CANPC, COSC

  5. #5
    Location
    Columbus, Ohio
    Posts
    105
    Smile
    Thanks for all the help. I have the AAOS global guide but didn't find anything in it to say it was included in the fracture care. My collections specialist will be happy that she was right. She thought it was incidental. I will have to watch out for that from now on ,although this was the first time I had it denied. thanks again for your responses. Paula

  6. #6
    Default
    Well, then I am learning something here too!

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