Wiki Coding Challenge - Staged Orthopaedic Procedure.

[CVANE]

Correct Coding of Staged Procedure:

DX: 821.33 Open supracondylar fracture femur
(motorcycle accident)

Stage 1: ORIF of femoral supracondylar; ID skin, muscle, bone; implant antibiotic cement spacer. (patient with significant bone loss)

Stage 2: ID skin, muscle, bone; removal of antiobiotic cement spacer; insertion of bone graft substitute (Stryker HydroSet 15ml)

Note: Patient opted for the bone graft substitute in lieu of an autogenous graft. Trauma case studies show the rate of infection to be lower with a bone graft substitute than an iliac crest graft. Stage 2 was performed 4 days after Stage 1.

 

[Bella Cullen]

Correct Coding of Staged Procedure:

DX: 821.33 Open supracondylar fracture femur
(motorcycle accident)

Stage 1: ORIF of femoral supracondylar; ID skin, muscle, bone; implant antibiotic cement spacer. (patient with significant bone loss)

Stage 2: ID skin, muscle, bone; removal of antiobiotic cement spacer; insertion of bone graft substitute (Stryker HydroSet 15ml)

Note: Patient opted for the bone graft substitute in lieu of an autogenous graft. Trauma case studies show the rate of infection to be lower with a bone graft substitute than an iliac crest graft. Stage 2 was performed 4 days after Stage 1.

So are you asking if you would put a 58 on the stage 2 procedure? I would say yes if that is your question.

 

[CVANE]

Thank you for your reply. No. Modifier -58 is not the issue. I would like feedback which cpt code to use for the HydroSet bone graft in Stage 2.

 

[Bella Cullen]

oh ok sorry.
Look at 20902 see if that would work.

 

[CVANE]

Here is the answer to this coding challenge:

Stage 1:

821.33, 821.31

27513
11012-51
11981-51

Stage 2:

821.33, 821.31

27599
11012-51
11982-51

Using cpt 20902 would not be appropriate since cpt 20902 includes obtaining the graft (which is not performed when using a synthetic graft).

Here is a very good tip. One I have used more than once. I contacted the manufacturer of the synthetic bone graft compound; discussed the correct coding of the surgery with one of their reimbursement specialist. The charge amount we are using is 60% of code 20902. The charge amount was reduced by 60% to account for the fact the "obtaining of the graft" was not performed.

 

[CVANE]

Addendum:

Stage 2:

add modifier -58

 

[mbort]

Where did this "coding challenge" come from? Not sure I am buying what they are selling for the Stage II procedure (at least not without seeing more of an op note)