Wiki CPT Codes Help! Monteggia variant surgery

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afisch1245

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My provider did a Monteggia variant surgery. See surgery details attached. He put CPT codes 24685, 24666, 24343, 24635, 24301, 64718, 77071, 24586. Isn't 24635 (Monteggia) inclusive of 24685 (ulnar), 24666 (radial head) and 24586 (periarticular) in this case? I am leaning towards billing 24685-22, 24666-59, 24343-59, 24301-22,59, 64718 and 77071. Let me know your thoughts. Thanks in advance!

ICD 10 codes: S53.104A, S52.121A, S52.041A, S52.021A, S53.431A
 

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A lot going on here. However, if it is Monteggia or Monteggia variant, it is 24635. Monteggia has its own CPT. There is no statement or justification for modifier 22 . Yes it was a terrible triad, comminuted, multiple structures and very big case. However, it would be best if there was justification to better support the 22 modifier. Surgeons can put a statement in the header or at the end to help with this. Just slapping "modifier 22" on the op note is not good enough. A statement with this type info clearly spelled out is better:
https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00135206 https://www.aapc.com/blog/63312-when-to-append-modifier-22/
Documentation must support the substantial additional work and the reason for the additional work such as:
  1. Increased intensity
  2. Time
  3. Technical difficulty of procedure
  4. Severity of patient’s condition
  5. Physical and mental effort required.
I am seeing:
24301 Anconeus advancement
24666 Radial head arthroplasty (24343 included per AAOS GSD)
24635 Monteggia (higher RVU and more correct vs. 24685) (24343 included per AAOS GSD)
64718-59 Ulnar nerve (not included per AAOS GSD)
(This is based on NCCI edits. If this was WC it would be different. Depends on payer)
 
amyjph said:
A lot going on here. However, if it is Monteggia or Monteggia variant, it is 24635. Monteggia has its own CPT. There is no statement or justification for modifier 22 . Yes it was a terrible triad, comminuted, multiple structures and very big case. However, it would be best if there was justification to better support the 22 modifier. Surgeons can put a statement in the header or at the end to help with this. Just slapping "modifier 22" on the op note is not good enough. A statement with this type info clearly spelled out is better:
https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00135206 https://www.aapc.com/blog/63312-when-to-append-modifier-22/
Documentation must support the substantial additional work and the reason for the additional work such as:
  1. Increased intensity
  2. Time
  3. Technical difficulty of procedure
  4. Severity of patient’s condition
  5. Physical and mental effort required.
I am seeing:
24301 Anconeus advancement
24666 Radial head arthroplasty (24343 included per AAOS GSD)
24635 Monteggia (higher RVU and more correct vs. 24685) (24343 included per AAOS GSD)
64718-59 Ulnar nerve (not included per AAOS GSD)
(This is based on NCCI edits. If this was WC it would be different. Depends on payer)
Click to expand...

Thank you Amy for the time spent and detailed explanation! May I know why you did not include 77071?
 
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