# tibial plateau fracture



## NEOSM507 (Nov 22, 2017)

Question from physician:

A young woman had a tibial plateau fracture that was fixed out of state.  She had a screw which was too long so I performed a procedure to remove the one screw and replace it with a shorter one.  Should I just code removal of deep implant?

Thank you for your responses, Happy Thanksgiving


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## Orthocoderpgu (Nov 24, 2017)

*Question from physician*

That's what I have done in the past. 

At this point the physician is not really treating the "fracture" so the ORIF code with modifier -77 would not be appropriate.


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## NEOSM507 (Nov 25, 2017)

thank you


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## AlanPechacek (Nov 26, 2017)

I would disagree with the previous response to this query.   If the only procedure done was *Removal* of the screw that was too long, then 20680 would be correct, but the descriptor for 20680 does not include *Replacement *with another screw.  
     There is a lot of missing information about this case such as the time line for when the patient was originally injured and had her index procedure.  If it was recent enough that the fracture had not healed completely, and was still in the healing process, then this procedure would qualify as a *Revision *ofthe Open Treatment of the Tibial Plateau Fracture with Internal Fixation, 27535 (assuming this was a unicondylar fracture).  CPT doesn't really address "Revision of Internal Fixation" as an identifiable procedure as it does for Joint Prostheses/Arthroplasties of the Knee and Hip, where there are specific codes.  Therefore, in this situation, one would have to consider this *"Revision"* to be a *"Repeat"* of the original procedure, 27535, *if* the fracture was still sufficiently acute/subacute so as to still be healing, and the screw fixation was still necessarily to maintain the stability of the fracture reduction/alignment.  If this is the case, then he could have used the 27535 code again with the *77 Modifier: Repeat Procedure by Another Physician*.
     Hopefully the preoperative and postoperative diagnosis codes for this case are determined and listed so as to "justify" this "Revision/Repeat" procedure, i.e. what symptoms/complaints by the patient, pertinent physical and X-ray findings etc. are documented that indicate that this particular "too long screw" is a clinical problem warranting its removal and replacement.
     By accepting the 20680 procedure alone, I believe the surgeon is "shorting" himself in the care of this patient.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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## Orthocoderpgu (Nov 27, 2017)

*You are correct Dr. Pechacek, M.D.*

You are correct. I assumed in my response that the hardware was in place for a while and was causing issues. That's generally what I see in situations similar to this.

One of the issues that we have as coders is not enough time to speak to our surgeon's about things like this. Some surgeon's understand the importance of communication so things like this can be addressed. Other surgeon's don't want to communicate with coders and it does cause issues.


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## AlanPechacek (Nov 28, 2017)

Orthocoderpgu said:


> You are correct. I assumed in my response that the hardware was in place for a while and was causing issues. That's generally what I see in situations similar to this.
> 
> One of the issues that we have as coders is not enough time to speak to our surgeon's about things like this. Some surgeon's understand the importance of communication so things like this can be addressed. Other surgeon's don't want to communicate with coders and it does cause issues.



*"Documentation, Documentation, Documentation!!!"*


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