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Ortho opinions....PLEASE!!!

  1. #1
    North Carolina
    Default Ortho opinions....PLEASE!!!
    Medical Coding Books
    Ok…I’m going to try to explain this without confusing you or for that matter…myself.

    Patient was seen 10-12 for consult and reduction of radial fracture and bimalleolar reduction. Both were closed reductions

    Consult and reduction 10-12-09

    I discussed the patient's case with Dr ***, and he reviewed the patient's recent cardiac studies and felt that she could be safely sedated for reduction of her left ankle and left distal radial fractures in the emergency room. This was done under his guidance, and closed reduction with manipulation of both the volar Barton fracture of the distal radius as well as the bimalleolar ankle fracture were performed, with the ankle reduction stabilized with a short leg fiberglass cast and the wrist splinted with a plaster coaptation splint. I had discussed the need for reducing these fractures with the patient this evening and told her that if she was cleared medically for surgery that her wrist and possibly the bimalleolar ankle fracture would be best treated surgically, which can be done tomorrow or when she is medically cleared.

    On 10-13, the patient was taken to the OR and had….

    10-13-09 PROCEDURES:
    1. Open reduction, internal fixation of left distal radial fracture with a volar locking plate.
    2. Left carpal tunnel release.
    3. Closed reduction with manipulation and splinting of the left 5th metacarpal neck fracture.

    Now since the closed radial fracture was performed on 10-12 but went to a open reduction on 10-13, I’m inclined to only capture the 10-13 open reduction. (This is a Medicare patient)

    So this is what we have so far…..


    9925* (mod 57)



    Now…My next question…Since 27810 (10-12) has a 90 day global period, 10-13-09 will hit edits. I don’t really want to use 78 because we knew she had to go back to the OR for the remaining procedures…we just had to make sure she was ok for clearance. I don’t want to use 79 because 10-13 is related to 10-12’s visit. The only other modifier I see “workable” is 58….

    Any and ALL opinions are welcomed….
    Last edited by RebeccaWoodward*; 10-20-2009 at 12:11 PM.

  2. #2
    mod 58
    Angelica Stephens RHIT, CPMA, COSC, CCS-P, CPC, COC.
    Albuquerque, NM

  3. #3
    North Carolina

    I'm getting some super feedback...

    Recommendation is...bill for BOTH closed reductions for 10-12-09.

    10-13-09 Bill 58 and 79 accordingly

    Review 64721---Maybe not be able to charge if the CTR is prophylactic with no documented nerve studies showing CTS. Below is the reason for the procedure...

    (dictation) “……I was therefore concerned that the patient might develop a traumatic carpal tunnel syndrome, and therefore decided to proceed with a carpal tunnel release….”

  4. #4
    I agree with billing for the closed reductions and modifier 58 on the OR for open treatements. I have actually had a situation similar to this recently and billed for 64721 and was paid. I do not have any documentation on this but would think the insurance would rather pay for this treatment now than later in a seperate trip to the OR. Just an opinion

  5. #5
    North Carolina
    Thank you April. After reading over the op note a few times and discussing it with my surgeon, we decided to report 64721. We shall see...

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