Orthopedic Coding Alert

Question: My surgeon spent 10 to 15 minutes on a patient, attempting a closed reduction with percutaneous fixation of a finger, but the fracture remained shortened and rotated. He then performed an open reduction with internal fixation. Should I use 26727 with modifier -52 for reduced services and then 26735 for the open procedure?

Idaho Subscriber

 
Answer: Per the AAOS Global Service Data Guide, 26727 (percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each) is bundled under 26735 (open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with or without internal or external fixation, each), so most payers are likely to reject the claim for 26727, even with modifier -52 (reduced services) appended. Instead, you could try to bill 26735 with modifier -22 (unusual procedural services) and send along the operative report indicating the time spent on the attempted closed reduction.