# Closed reduction to open reduction...



## BCrandall (Sep 19, 2008)

Here's my question. If a closed reduction of metacarpal frcture was attempted (X3) then converted to an open reduction in the OR, can I code the closed reduction with a -52 and the open reduction? Or should I use -74 on the closed procedure? OR do I only code the open reduction?


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## mbort (Sep 19, 2008)

Sorry Bruce, you can only capture the open procedure.  As long as its well documented, you can add the 22 modifier.  Be sure to add the dx for "closed converted to open" V code.


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## BCrandall (Sep 19, 2008)

Thanks Mary! 
This is for hospital outpatient so I can't use -22. I forgot about the open to closed code  that's why I was shooting for using the closed CPT with a modifier...


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## dmaec (Sep 19, 2008)

once it converts from closed to open, you code only the open procedure.  No modifier needed.

_{that's my opinion on the posted matter}_


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## mbort (Sep 22, 2008)

Thats correct Bruce, for the facility you can not use the -22 modifier.

HOWEVER IF one were billing for a physician then the 22 would be appropriate for the 3 attempted closed reductions prior to opening providing the documentation supported the -22.

Mary


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## dmaec (Sep 22, 2008)

I'd agree with your use of modifier .22 mbort - but then I think we'd both be wrong.  Modifier .22 is for "increased Procedural Services:  When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier .22 to the usual proceure code. Documentation must support the substantial additional work and the reason for the additional work.
So, "IF" the "original" procedure that took 3 tries FINALLY was completed, then yes - modifier .22 would be correct (documentation supporting of course), but the "open" procedure is not the "usual" procedure for this scenario, the closed was - it just so happens that it went from closed to open.  And when a procedure goes from closed to open, the open procedure is coded (which is a significantly higher cost than closed). Once they went to open, if that took longer than "usual" then a modifier .22 could be added (documentation supporting of course) (for physician)

anybody else have an opinion on the use of 22 modifier in this scenario - closed x3 failed, convert to open....??  maybe I am way off base....


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## Frosty (Sep 23, 2008)

I agree that you COULD use the 22 mod in this instance - if the work involved in the closed reduction attempts did add significantly to the work/time involved in the overall procedure.  Even though the closed procedure was converted to open and you're no longer using the closed proc code, the work involved in the closed part of the procedure would then be considered part of the open procedure code.  That's how I look at it anyway.


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