# Need some help, please.



## tammster (Oct 15, 2009)

*broken implant / new surgery*

Any suggestions on how this should be billed?

The doctor insists that this current procedure should be billed as 28675.  But, I'm not convinced.  Our department thinks this should be billed as an unlisted 28899.  Any thoughts?

he removed an old broken implant and went on to describe this in his operative report:
...dissection was continued down to bone and the periosteal tissuses were reflected laterally and medially exposing the fractured bone at the operative site.  The fusion between the middle and proximal phalanges was fractured.  The middle phalanx was displaced medially.  Reduction of the fracture was performed.  Hematoma ws removed.  Due to the forces placed on the fusion site to fracture an implant and fracture a previous arthrodesis, a decision was made to fixate the fracture using a medullary rod.  Next, using standard technique and instrumentation the medulary canals of the proximal and middle phalanges were drilled and a Shaw Rod implant was inserted...

Please note:
This is a toe that the doctor billed a hammertoe on (in April of 20007) notes stated "transverse tenotomy and capsulotomy was performe to the proiximal interphalangeal joint"

same toe in June 2009, doctor performed surgery again stating "...digit was contracted at the proximal interphalangeal joing and curved medially..a transverse tenotomy and capsulotomy was performed to the joint...a smart toe digital implant was inserted..."



Any feedback would be appreciated!!


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## tammster (Oct 19, 2009)

Anybody...???


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## BCrandall (Oct 21, 2009)

28675 is for a dislocation, this seems to be a non union of a fusion. I'd code for a complication of internal fixation device (996.78) for Dx and look at 28312 for the CPT code.

Good Luck!


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## tammster (Oct 22, 2009)

Thanks for the help!!


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