Wiki MUA with ex-fix removal

[kimmcelderry@gmail.com]

Would you bill 27860 and 20694 together?

Op note snippet:
We started by disassembling the Ilizarov ring external fixator and removing it in entirety with all smooth wires and Schanz pins.
We irrigated and debrided the lateral ankle wound around one of the pin sites 3 cm x 2 cm. Debridement carried out with curette and rongeurs removing all necrotic tissue reaching a healthy bleeding tissue.
We performed manipulation of the ankle under anesthesia and fluoroscopy. AP views of the ankle with varus and valgus stress were obtained and independently reviewed as well as lateral views with stress testing. There was no motion at the fusion site with a completely plantigrade foot

Thank you

 

[amyjph]

This looks like 77071 to me, not 27860.

 

[amyjph]

What was the intent of the manipulation? Did they have a dislocation? Why was the ex-fix on, open fx which was too swollen to close/treat initially? Was it an ankle fusion with later complications? I still say it's 77071. Without seeing the full story/note. If they were doing stress testing/manipulating to assess motion at the fusion site.
See NCCI manual" https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
14. When it is necessary to perform skeletal/joint manipulation under anesthesia to assess range of motion, reduce a fracture or for any other purpose during another procedure in an anatomically related area, the corresponding manipulation code (e.g., CPT codes 22505, 23700, 27275, 27570, 27860) is not separately reportable.

 

[kimmcelderry@gmail.com]

What was the intent of the manipulation? Did they have a dislocation? Why was the ex-fix on, open fx which was too swollen to close/treat initially? Was it an ankle fusion with later complications? I still say it's 77071. Without seeing the full story/note. If they were doing stress testing/manipulating to assess motion at the fusion site.
See NCCI manual" https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
14. When it is necessary to perform skeletal/joint manipulation under anesthesia to assess range of motion, reduce a fracture or for any other purpose during another procedure in an anatomically related area, the corresponding manipulation code (e.g., CPT codes 22505, 23700, 27275, 27570, 27860) is not separately reportable.

The patient had a hindfoot fusion for charcot with foot deformity. Thank you, I quoted that paragraph to the MD, but he does not agree.