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Removal of Hardware

  1. #1
    Grand Canyon Phoenix
    Default Removal of Hardware
    Medical Coding Books
    All you orthopedic guru's I need some clarification.

    Truama patient taken to surgery for an ORIF of distal radius with plates and screws by othro on call. Referred to my surgeon the hand specialists. My surgeon finds a "NEW" fracture distal to the plate. My surgeon has to remove the original plate "not put in by him" and replace with longer plate to cover now both fractures. We coded removal of hardware because we did not put the hardware in and ORIF of the "new" fracture. I am being denied the removal stating it does not matter who put the original plate in all is global. I do not agree!! Any thoughts???

    Signed Upset

  2. #2
    Milwaukee WI
    Default Modifier
    This is NOT my area of expertise, but ...

    Did you use any modifier? I would have put a -59 on the hardware removal to indicate that it was a separate proceduure from the fracture treatment.

    If the payor is adamant about the hardware removal being included, then you might want to consider adding -22 modifier to the basic fracture treatment code, and increasing your fee by X% for the added difficulty / time this took over and above the usual procedure.

    Just my thoughts ...

    F Tessa Bartels, CPC, CPC-E/M

  3. #3
    What code did you bill for the ORIF of the new fracture? I checked the edits for 25607, 25608, & 25609 and none of them show to have 20680 bundled.
    Eileen Blankenship, CPC
    Remote Coder

  4. #4
    Madison Area Chapter in Madison WI
    My understanding is the removal of the original hardware is considered part of the second hardware procedure. You can't do the replacement without removal of the original. Because it is much harder and takes more time, resources, etc to remove the hardware prior to the replacement, the 22 modifier is appropriate. I apologize because I don't recall where this is documented. I think it was in a CPT Assistant. Does anyone have anything to support this logic?
    Happy Coding, Claudia

    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email] - website

  5. #5
    I agree with Claudia and FTessa. Unfortunately you will not be able to capture for the removal on its own, so I would do a corrected claim with the 22 modifier and send the documentation to support it,

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