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Tip: Carefully code fracture care

Ambulatory Surgery Reimbursement Update, July 1, 2008

Have you noticed that the fracture care codes description in your 2008 CPT Manual now says “Includes Internal Fixation when performed” instead of “with or without internal or external fixation”? If your ASC performs fracture care note this change to code these procedures correctly. Otherwise, you may be leaving money on the table.

When your physicians perform external fixation in fracture care, code and bill it in addition to the fracture care procedure. However, double check the National Correct Coding Initiative (NCCI) unbundling material each time to ensure the codes you bill Medicare for external fixation are not bundled.

For the application of an external fixator performed with a uniplane (using pins or wires in one plane) system, use CPT code 20690. For the application of a multiplane unilateral external fixation system (using pins or wires in more than one plane), report code 20692. Code either of these codes in addition to the code for treatment of the fracture care. Use code 20693 for the adjustment or revision of an external fixation system requiring anesthesia [e.g., new pin(s) or wire(s) and/or new ring(s) or bar(s)]. For the removal of an external fixation system under anesthesia, report code 20694.

When coding for fracture care, consideration of the following issues will guide your coding:

• Where is the site of fracture or dislocation?
• Was the treatment open or closed?
• Was manipulation involved?
• Was skin or skeletal traction applied?
• Was skeletal fixation (percutaneous, external, or internal) applied?
• Was soft tissue closure performed?
• Were any grafts used?

If the surgeon first performed a manipulation, [e.g., an “attempted” reduction or restoration of a fracture or joint dislocation to its normal, anatomical alignment by manual application of applied forces (traction)], but the attempted manipulation or reduction procedure was not successful, you may still bill the code for treatment of the fracture with manipulation However, in keeping with CPT guidelines if the surgeon unsuccessfully performed a fracture manipulation or closed reduction and then performs an open reduction during the same case,, you may only bill the open reduction procedure. This tip is brought to you by Ellis Medical Consulting, Inc.

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