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Coding Challenge - Staged Orthopaedic Procedure.

  1. Lightbulb Coding Challenge - Staged Orthopaedic Procedure.
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    Correct Coding of Staged Procedure:

    DX: 821.33 Open supracondylar fracture femur
    (motorcycle accident)

    Stage 1: ORIF of femoral supracondylar; ID skin, muscle, bone; implant antibiotic cement spacer. (patient with significant bone loss)

    Stage 2: ID skin, muscle, bone; removal of antiobiotic cement spacer; insertion of bone graft substitute (Stryker HydroSet 15ml)

    Note: Patient opted for the bone graft substitute in lieu of an autogenous graft. Trauma case studies show the rate of infection to be lower with a bone graft substitute than an iliac crest graft. Stage 2 was performed 4 days after Stage 1.

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    Quote Originally Posted by CVANE View Post
    Correct Coding of Staged Procedure:

    DX: 821.33 Open supracondylar fracture femur
    (motorcycle accident)

    Stage 1: ORIF of femoral supracondylar; ID skin, muscle, bone; implant antibiotic cement spacer. (patient with significant bone loss)

    Stage 2: ID skin, muscle, bone; removal of antiobiotic cement spacer; insertion of bone graft substitute (Stryker HydroSet 15ml)

    Note: Patient opted for the bone graft substitute in lieu of an autogenous graft. Trauma case studies show the rate of infection to be lower with a bone graft substitute than an iliac crest graft. Stage 2 was performed 4 days after Stage 1.
    So are you asking if you would put a 58 on the stage 2 procedure? I would say yes if that is your question.

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    Thank you for your reply. No. Modifier -58 is not the issue. I would like feedback which cpt code to use for the HydroSet bone graft in Stage 2.

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    oh ok sorry.
    Look at 20902 see if that would work.

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    Here is the answer to this coding challenge:

    Stage 1:

    821.33, 821.31

    27513
    11012-51
    11981-51

    Stage 2:

    821.33, 821.31

    27599
    11012-51
    11982-51

    Using cpt 20902 would not be appropriate since cpt 20902 includes obtaining the graft (which is not performed when using a synthetic graft).

    Here is a very good tip. One I have used more than once. I contacted the manufacturer of the synthetic bone graft compound; discussed the correct coding of the surgery with one of their reimbursement specialist. The charge amount we are using is 60% of code 20902. The charge amount was reduced by 60% to account for the fact the "obtaining of the graft" was not performed.

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    Addendum:

    Stage 2:

    add modifier -58

  7. #7
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    Where did this "coding challenge" come from? Not sure I am buying what they are selling for the Stage II procedure (at least not without seeing more of an op note)
    Mary, CPC, CANPC, COSC

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