Orthopedic Coding Alert

Question: Our surgeon spent 10-15 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 26727-52 be used to report reduced services and 26735 for the open procedure?

Utah Subscriber

Answer: The Global Service Data Guide of the American Academy of Orthopaedic Surgeons indicates that 26727 (Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each) is bundled with 26735 (Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with or without internal or external fixation, each). Consequently, most payers will probably reject the claim for 26727 (even with modifier -52 [Reduced services] appended). You may try 26735 appended with modifier -22 (Unusual procedural services) but send the operative report to indicate the time spent on the attempted closed reduction.