Wiki Tibia Fx during knee replacement

[rubybluemonkey]

Please help,

Dr. Fractured patients Tibia during knee replacement.

Coded as:

27447 - 715.16
27535.51 - 823.00 (I think this is wrong since the doctor is the one who fx the tib)

Does anyone know what you would code for the fx Dx?

 

[OCD_coder]

First, you cannot and should not bill for a repair as a result of a surgeon "causing" the injury during a surgical session. The trauma was due to an accident during surgery. It's not unusual to fracture the bone when you are doing a TKA, they're hammering metal into the bone causing stress.

Second, these two codes bundle per NCCI edits and it is inappropriate to append with a modifier 59 as they are on the same bone as the 27447.

27447 27535 19960101 * 1

Third, you would have to use a "Misadventure" E-code as your 2nd Dx code for the 27535 and this will alert the insurance company that something was amiss.

 

[nyyankees]

First, you cannot and should not bill for a repair as a result of a surgeon "causing" the injury during a surgical session. The trauma was due to an accident during surgery. It's not unusual to fracture the bone when you are doing a TKA, they're hammering metal into the bone causing stress.

Second, these two codes bundle per NCCI edits and it is inappropriate to append with a modifier 59 as they are on the same bone as the 27447.

27447 27535 19960101 * 1

Third, you would have to use a "Misadventure" E-code as your 2nd Dx code for the 27535 and this will alert the insurance company that something was amiss.

I agree - you caused it you fix it. For FREE.

 

[rubybluemonkey]

Thank you! I am a bit new to ortho and thought it was odd that he would charge for that. Now I know how to approach the doc. Thank you.