Orthopedic Coding Alert

Question: Encounter notes indicate that the orthopedist performed open treatment on three rib fractures on the patient’s right side, and six fractures on the patient’s left side. Should I report a single fracture code with modifier 50 (Bilateral procedure), or two different repair codes?

Utah Subscriber

Answer: In this encounter, using modifier 50 (Bilateral procedure) to separate the repairs isn’t necessary, as you would use different codes for each rib repair.

Do this: On the claim, report 21812 (Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 4-6 ribs) for the left-sided fractures with modifier LT (Left side) appended to indicate laterality, if the payer requires it. Then, report 21811 ( … 1-3 ribs) for the right-sided fractures with modifier RT (Right side) appended to indicate laterality, if the payer requires it. Be sure to list 21812 on the first line of your claim, as you’ll want any deductions to apply to the lower-paying code (21811).

You would have used modifier 50 if you were reporting the same code for both sides of the patient; but in this case, you are reporting different codes because of the variance in fractured ribs. If the surgeon had provided open treatment to three ribs on each side of the patient, you would have reported 21811 with modifier 50 appended.