Wiki CPT help 27610 & 27614

[sugarjoe]

I am new to orthopedic coding and nervous with all the surgery coding.

My doc tells me he did this for a suspected deep infection after an ORIF of ankle fx 2 days prior:

Procedure: Irrigation and debridement with cultures x2, biopsies x2 and implantation of Stimulan antibiotic beads containing Vancomycin & Gentamicin.

Description: short version: Discolored tissue near medial malleolus, just superior & posterior to the fx, debrided & removed with a 15 blade knife. Cultures obtained as well. A piece of bone from medial malleolar region at fx site and another piece of bone at fx site at the fibula were sent to biopsy. The Stimulan beads were then placed.

He wants to bill 27610 & 27614. MR CCI edits state 27614 is a column 2 code for 27610. Would 27620 be more appropriate to include the biopsies he performed?

Any help with this is appreciated !!

 

[Orthocoderpgu]

In order to code this accurately, you would really need to post the redacted op note and pathology results. Code 27603 may fit, but really unknown. Smaller procedures are included with larger procedures when performed in the same area which is why 27614 hits an edit with 27610. If your already there, is it that much extra work to get a biopsy sample? Not at all. Code 27614 exists in case that is all that was done in that area but it would never be reported when a restorative procedure is being performed in the same area. Keep in mind that doctors understand that there is a procedure code for every procedure that they can perform, and after surgery they just list them all thinking that all can be billed. That's where coders come in. It's your job to make sure that all codes submitted are supported and correct per NCCI and insurance guidelines.

 

[RyanRaichCPC]

I agree with Orthocoderpgu, we would need to see the documentation in order to be sure as to which codes to advise that you bill. I would be happy to take a look at your dictation.

 

[sugarjoe]

Ok thank you. Here is the procedure note as dictated:

After adequate level of anesthesia obtained, the right ankle was prepped & draped in normal sterile fashion. At this time, appropriate time-outs were performed. When this was completed, the prior sutures were removed, skin, 4-0 nylon sutures removed. Each wound had been closed with Vicryl and care was taken to identify each Vicryl suture and remove it. At this time, cultures both medial and lateral were obtained. At this time, I took a piece of bone from the medial malleolar region at the fracture site and another piece of bone at the fracture site at the fibula, sent 2 separate specimens for biopsy to evaluate for acute and/or chronic osteomyelitis. At this time, 6 L of plulsatile DABS solution was irrigated through the wound and then preoperatively Stimulan antibiotic beads were formed using a 10mL of Stimulan, 1 gm vancomycin powder and 240mg of gentamicin liquid were mixed. A small bead tray was used. These were hardened. Approximately half of this total amount of beads were placed medially and laterally, anteriorly in the ankle, filling the voids. It should be noted prior to this and prior to the irrigation and debridement, there was discolored tissue, particularly near the medial malleolus, just superior and posterior to the fracture. This was sharply debrided and removed with a 15 blade knife. Medially, there were small amounts in the anterior aspect of the fibula that were removed with a 15 blade knife. At the end of the case, after the beads were placed, the wounds were closed with 4-0 simple interrupted nylon sutures.

Is this enough info for be reviewed? I believe cultures & biopsies were negative.