Orthopedic Coding Alert

Question: One of our surgeons wants me to bill 20690 (Application of a uniplane [pins or wires in one plane], unilateral, external fixation system) with 25611 (Percutaneous skeletal fixation of distal radial fracture [e.g., Colles or Smith type] or epiphyseal separation, with or without fracture of ulnar styloid, requiring manipulation, with or without external fixation). Should we append a modifier to bill both codes?

Arizona Subscriber

Answer: You cannot report both of these codes for the same site because 25611 states, "with or without external fixation," and the Correct Coding Initiative bundles 20690 into it.

Because 25611 includes fixation, appending a modifier to 20690 so it will pass through the carriers editing process would be considered "unbundling," a practice you do not want to perform, because it might be viewed by the payer as attempting to game the system. When the orthopedic surgeon performs both of these procedures, report only 25611 to the insurer.