Orthopedic Coding Alert

Question: Our surgeon did an open repair and internal fixation with Vitoss bone graft for a non-union of the clavicle. The operative note stated that “rongeur and curette” were used. Does this imply an osteotomy? Is it correct to report code 23480 (Osteotomy, clavicle, with or without internal fixation) or do we report an unlisted code? Is it ok to append modifier 52 (Reduced services)?

Wisconsin Subscriber

Answer: You are not correct to report code 23480. You report this only when osteotomy is documented. You report code 23515 (Open treatment of clavicular fracture, includes internal fixation, when performed) for open reduction and internal fixation of clavicle. You cannot code for the addition of the allograft. Rongeur and curette do not imply an osteotomy. They are simply used to remove the fibrous material in the non-union. If an osteotomy had been performed, the operative note would have described the use of osteotomy or an oscillating saw. Modifier 22 (Increased procedural service) may apply for this revision surgery, if your physician’s documentation supports it.