Orthopedic Coding Alert

Question: We have always billed for the removal of external fixation with 20694 (removal, under anesthesia, of external fixation system) and usually a -58 modifier (staged or related procedure or service by the same physician during the postoperative period) if the patient is still in the global period. But sometimes the external fixation system is removed in the office without anesthesia. Should this be billed, and if so, with what code? Should a physician other than the one who applied the external fixator only use code 20694, or is that just for fixation that did not stay in place? What about when the physician that applied the fixator has to take the patient back to the operating room (OR) and remove it under anesthesia? Can this be charged?

Billie Jo McCrary
Wellington Orthopaedic and Sports Medicine
Portland, Ore.

Answer: If the procedure is performed in the OR under general anesthesia, it is billable. If performed in any location under conscious sedation, it is considered part of the global. If removed by a different physician who is under the same group ID number of the original physician, it is considered part of the global. If removed by a physician from a different practice, it is billable.