Orthopedic Coding Alert

Question: Our patient underwent an open reduction/internal fixation (ORIF) of a mid-shaft humeral fracture, but now is experiencing loosening of the proximal portion of the locking plate above the fracture site. Our surgeon (who performed her original surgery) took her back to the OR and performed a procedure revising the proximal portion of the locking plate to three different screws and two cerclage cables x 2 as well as adding Dynagraft. We are unsure of which CPT code to use in this circumstance other than 20680 for removing the three screws. Can you advise?
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Answer: It sounds like your surgeon performed another fracture repair, which you’ll report with 24515 (Open treatment of humeral shaft fracture with plate/screws, with or without cerclage). You would also report code 996.49 (Other mechanical complication of other internal orthopedic device, implant, and graft) to capture the mechanical complication (loosening of the locking plate).

You won’t report 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) for the screw removal, because the revision is paid as a full value repair code and therefore includes the cost of removing the previous instrumentation.

You didn’t mention whether the patient is still in the global period of the original fracture repair. If so, you’ll want to add modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to 24515.