Wiki Planned ORIF following CLOSED RED w External Fixation

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dimplez

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Ok - am I losing my mind? Is it not appropriate to report a closed reduction with the application of an external fixation even when the ultimate plan is to return the patient to the OR for an ORIF? Yes, I understand that a modifier (58) will need to be applied to the return. An example would be if a patient has a complicated open fx and they do debridement, closed reduction and ex fix - several times - and THEN do the final ORIF. My thoughts are what if the patient dies before they can bring the patient back for the final ORIF - you lose the initial reduction. Another situation would be what if the pt NEVER returns.......weird, but I have seen it happen. (pt's fx wasn't open, but they had to wait for the swelling to go down)

Does anyone have like an AAOS article or some type of resource on this? I am getting push back on this......HELP?????
 
It is always appropriate to report closed reduction and external fixation when it is performed, even if it is not the definitive fixation. If there is a planned return to the OR, then using the -58 modifier on the follow up procedure is appropriate. This would reset the global period to begin on the date of the second procedure but would not limit reimbursement from the second procedure.

Who are you getting pushback from, and why?
NCCI pretty clear that restrictions on billing a secondary fracture procedure only apply when they are performed at the same setting, and that does not apply here.
 
Not the surgeons, but the coding supervisor and manager. I am new to the organization (as a SME/liaison for the surgeons) and have identified that they are not doing that for trauma patients...the operative notes even state that the fx is aligned with tightening of the external fixators. On one patient, they did not return, so revenue lost. :( So now I am like I am like just because it was the plan, it doesn't always mean that it will happen.
 
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