Wiki Reconstruction distal biceps with Achilles allograft

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RebeccaMoney

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My physician did the above but feels that CPT 24342 does not properly capture what he did. He said this was a chronic tear and the repair is more complicated than the 24342. Do you think modifier 22 might work or is there a better code? Any other suggestions? I need help ASAP.
Thank you,
 
Can you post a screen grab without PHI of the note so I can see how this was repaired? Also in order to substantiate modifier -22 on your claim, the physician's documentation should state that this case took a significant amount of extra time or effort due to patient condition, excessive blood loss, presence of the unhealed fracture, difficult nature of the procedure due to increased effort on his/her behalf whether mental or physical, etc (to name a few). This MUST be documented in the op note to utilize the modifier appropriately and sucessfully. If you post the note, I would be happy to give my opinion.
 
RyanRaichCPC said:
Can you post a screen grab without PHI of the note so I can see how this was repaired? Also in order to substantiate modifier -22 on your claim, the physician's documentation should state that this case took a significant amount of extra time or effort due to patient condition, excessive blood loss, presence of the unhealed fracture, difficult nature of the procedure due to increased effort on his/her behalf whether mental or physical, etc (to name a few). This MUST be documented in the op note to utilize the modifier appropriately and sucessfully. If you post the note, I would be happy to give my opinion.
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No op note available yet. I suggested modifier 22 to him and told him to make sure that he documents the extra time & effort spent.
 
Your physician is probably correct. A chronic tear can be more complicated and time consuming that a recent tear of the tendon due to adhesions, scar tissue forming and other complications. As far as coding, there is no separate code for this in this case. There is for an Achilles tendon tear, but not of the biceps tendon. You will need to use modifier -22 for the additional time & skill involved with the repair, but the physician needs to do their part by including the additional work and the reason for it in the op note. Some docs are much better than this than others. The better your doctor documents this, the better chance you have with the insurance company paying extra.
 
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