Use Multiple Modifiers to Correctly Code for Multiple Trauma
Published on Tue Feb 01, 2000
Understanding when to use modifiers -50, -51, -59, -79 and -99 is vital to correctly code for multiple traumas such as those resulting from a car accident.
These car accidents often result in multiple skeletal injuries, which an orthopedic surgeon (OS) treats in a single (emergency) operating room (OR) session. The coders challenge comes later, telling the complete story, but not telling it more than oncethus avoiding duplicate billing. A common, but fictional, scenario illustrates the path to coding solutions.
Scenario: A driver fell asleep at the wheel and overturned his car on an interstate highway. He sustained multiple skeletal injuries in the serious one-car accident. A neurosurgical team admitted the patient and called in a consulting OS. The OS assumed responsibility for the treatment of the skeletal injuries.
During the initial operating room session, the OS debrided and closed an open knee (right) laceration, did an open repair of a syndesmosis disruption on the right ankle and pinned a left calcaneus fracture. The OS also treated bilateral talar neck fractures with open reduction and internal fixation, and treated a fifth metatarsal fracture with intramedullary screw fixation and a left foot Lisfranc fracture dislocation with open reduction and pinning.
Six days later, the patient underwent an open repair (same OS) of a pelvic ring disruption (open reduction and internal fixation). The OS had not staged a repair of the pelvis during the first OR session.
The ICD and CPT codes that apply to the injuries are listed in the box on page 11. One reminder, however, is that this scenario also should be coded with the correct E (external causes) code from the ICD listings.
Coding: Here, the correct E code is E816.0 (motor vehicle traffic accident due to loss of control, without collision on the highway), which includes falling asleep at the wheel and overturning the car. E codes are never substitutes for primary diagnosis codes.
Modifier Questions
When coders look at this scenario, they are likely to ask two questions immediately. 1. Which is the appropriate modifier to use to code for the treatment of the bilateral talus fractures? 2. Which modifier applies to the repair of the pelvis, which was not staged during the first OR session?
Bilateral talus fractures: On first review of the treatment for bilateral talus fractures, some coders begin thinking about three modifiers. Modifiers -50 (bilateral procedure), -51(multiple procedures) and -59 (distinct procedural service) seem relevant.
In fact, at most, only two of the modifiers, -50 and
-51, are applicable. And whether both are used depends on the sort of payer the patient has.
Blair C. Filler, MD, FACS, director of medical education at Los Angeles Orthopaedic Hospital, explains. If this is [...]
