Wiki Metacarpal ORIF with Osteotomy

[JoannaParz]

Hello all,

My provider is giving me CPT codes;

26565 (Osteotomy; metacarpal, each)​

26615 (Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone)​

ICD10: S62.241P (Displaced fracture of shaft of first metacarpal bone, right hand, subsequent encounter for fracture with malunion)​

(operative report attached)
I feel as though if he is performing the ORIF the removal of bone (wedge osteotomy) would be necessary in order to repair the malunion.

Any advice is greatly appreciated!
thank you

 

[Orthocoderpgu]

Your instincts are correct. Additionally, these codes hit an NCCI edit. That means that there would need to be some "separation" between the two procedures in order to bill them out such as separate incisions and so forth. Your physician is coming at this from a different angle than you are. They just go to surgery and write down all the procedures performed. It's up to the coder to determine which codes are billable.

 

[JoannaParz]

Your instincts are correct. Additionally, these codes hit an NCCI edit. That means that there would need to be some "separation" between the two procedures in order to bill them out such as separate incisions and so forth. Your physician is coming at this from a different angle than you are. They just go to surgery and write down all the procedures performed. It's up to the coder to determine which codes are billable.

thank you so much!