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Thread: new to ortho coding and need help

  1. #1
    Join Date
    Apr 2007

    Default new to ortho coding and need help

    AAPC: Back to School
    If you have a patient in the er for whom you do a closed reduction of the ankle and then take them to the OR and do an Open reduction of that ankle, my gut reaction is that you can not bill for the closed reduction. Correct?

    also, many of the ortho cases I am billing for are trauma cases so the open fractures that the docs are seeing are pretty bad. Can we bill for the 11012 in addition to the individual repair codes for the open fractures if the debridement is beyond what is considered "normal"?

    Thank you.

  2. #2


    If you do closed reduction in the ER and then say a week or so later determine that open
    reduction is needed, you can charge for both. In other words, in the ER, the Dr made the determination that the fracture could heal nicely without surgery, but later on he
    has found that it is not staying in alignment or healing properly, then you can charge the
    open procedure with a 58 modifier.

    Yes you can charge the 11010-11012 with trauma fractures that need debridement.

  3. #3
    Join Date
    Apr 2007


    Thank you. In the case of the closed to open - they were both done on the same day.

  4. #4


    In that case, I would only code the open procedure.

    And don't forget your 57 modifier on your E & M code ( decision for surgery)

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