Surgery revision question (coding)

[NatCh]

What procedure code(s) did you end up using?

---

Members don't see this ad.

 

[billBOB213]

HWR 20680
Hopefully its right!lol

 

[NatCh]

HWR 20680
Hopefully its right!lol

-78 modifier (unplanned return to the OR)?

 

[NatCh]

20680 doesn't quite seem like it's exactly what you did though since that's just hardware removal but you then put it back in.

Not sure but would a 28296-76 also fit (repeat procedure by same physician)? Also not exact because you didn't re-create the osteotomy. Hmmmm.

 

[Jummy Biffett]

It’s still used in Europe but is not profitable and therefore will never be pushed by the medical device industry in the US

THIS

 

[billBOB213]

20680 doesn't quite seem like it's exactly what you did though since that's just hardware removal but you then put it back in.

Not sure but would a 28296-76 also fit (repeat procedure by same physician)? Also not exact because you didn't re-create the osteotomy. Hmmmm.

Yes, went back and forth on both for that same reason, as both don’t truly fit 🤷🏻‍♂️
I liked the 76 modifier buuuut didn’t do osteotomy, just took out a screw and put a different one in

 

[NatCh]

Yes, went back and forth on both for that same reason, as both don’t truly fit 🤷🏻‍♂️
I liked the 76 modifier buuuut didn’t do osteotomy, just took out a screw and put a different one in

Bill for both!


JK, no don't do both.

 

[NatCh]

I think that proximal screw was too long and pushed the capital fragment distally

I took part in an Arthrex MIS training session yesterday and brought up your case with the instructor. He speculated exactly what you said above.

Furthermore, holy learning curve. Who wants to be my first patient? Not me!

Did you use the C-clamp jig or the guide thing with the multiple holes?

 

[air bud]

I took part in an Arthrex MIS training session yesterday and brought up your case with the instructor. He speculated exactly what you said above.

Furthermore, holy learning curve. Who wants to be my first patient? Not me!

Did you use the C-clamp jig or the guide thing with the multiple holes?

Shadow dtrack on a few

 

[NatCh]

Shadow dtrack on a few

I bet that would be helpful. Getting the feel of it in my own hands is what I’d like. Cadavers aren’t quite like an actual patient.

 

[ExperiencedDPM]

Bill for both!


JK, no don't do both.

To answer the original question, you 100% can not bill a bunionectomy code. You are not removing the eminence and re-performing an osteotomy. Even with any modifier, it would be 100% incorrect.

20680 can be billed, but only for one unit. Only one unit is payable at the same anatomical location.

In all honesty, I would likely not bill anything and take the punch to the gut. It’s all about doing good work and making your patient happy. This is something that likely should have been caught in the OR or intra op/post op film.

The last thing I’d worry about is billing for a complication not caused by the patient this soon post op.

Just do the right thing for the patient and don’t worry about the few bucks you’ll make. That additional fee has the potential to piss off the patient.

Trust me from someone who has turned down accepting lawsuits on these type of cases. It’s rarely the patient who initiates the law suit. It’s one of their friends or relatives who convinces them. It’s NOT malpractice and these things happen.

Again, I would personally do the case and as good will I would not charge. And if anyone says not charging is an admission of guilt, I could not disagree more.

Just my opinion.

 

[NatCh]

The last thing I’d worry about is billing for a complication not caused by the patient this soon post op.

Excellent point. Make sure to blame the patient!

 

[ExperiencedDPM]

Excellent point. Make sure to blame the patient!

No, that’s when you’re schniding a callus and bury your blade and immediately yell out “why did YOU move?”

 

[Feli]

One thing to seriously consider in this situation is to not submit a bill... yes, seriously. @ExperiencedDPM hit the nail on the head.

When it's a purely technical error in the surgery execution, you can always decline to submit anything on the re-do.

And no, you can't stop the hospital or ASC, the anesthesia, etc from submitting their larger billing for the retry date... but you can decline to submit a surgeon bill.

It is one thing if it's a normal post-op complication like delay union or abscess needing I&D... but in some of these cases, it will be pretty obvious to the pt and the family that there was an airball screw, malreduction, didn't have the right screwdriver and didn't do the HWR or full HWR, tendon transfer or pin pulled/fell right out within a week or two, etc. In such cases, sometimes it goes a looong way to take accountability and inform the patient you declined to charge them for making it right... esp when the XR speaks for itself. It obviously depends on your practice situation and the case in question, but it can just be a good thing to do in many, many ways. (and I can't take credit for this... learned this from a well-trained surgery prof as a pod student)

 

[ExperiencedDPM]

One thing to seriously consider in this situation is to not submit a bill... yes, seriously. @ExperiencedDPM hit the nail on the head.

When it's a purely technical error in the surgery execution, you can always decline to submit anything on the re-do.

And no, you can't stop the hospital or ASC, the anesthesia, etc from submitting their larger billing for the retry date... but you can decline to submit a surgeon bill.

It is one thing if it's a normal post-op complication like delay union or abscess needing I&D... but in some of these cases, it will be pretty obvious to the pt and the family that there was an airball screw, malreduction, didn't have the right screwdriver and didn't do the HWR or full HWR, tendon transfer or pin pulled/fell right out within a week or two, etc. In such cases, sometimes it goes a looong way to take accountability and inform the patient you declined to charge them for making it right... esp when the XR speaks for itself. It obviously depends on your practice situation and the case in question, but it can just be a good thing to do in many, many ways. (and I can't take credit for this... learned this from a well-trained surgery prof as a pod student)

Was I your well trained surgery professor? Just sayin’….

 

[Pronation]

Was I your well trained surgery professor? Just sayin’….

No, he’s referring to a person who is much more gooder and more smarter, Dr. Merton L. Root III.

 

[Feli]

Was I your well trained surgery professor? Just sayin’….

Yah, kinda an oxymoron, lol.
He actually is, though... probably almost better training than you or I. He went to PI back in the day when it was one of the very few good programs... not usualy the kind of guy you'd have lecturing at a pod school. He was a local residency director also... he was real valuable not just in technical/boards surgery but mainly for pearls on how to be a good doc and talk to pts. I liked him a lot. Maybe it's a PI thing to not bill for surgeon error re-do cases... I liked the idea of it a lot and made it a part of my practice if ever needed.

Pod school faculty usually don't have that... unless it's UTRGV apparently throwing them a boatload of $$$ to get good names

 

[ExperiencedDPM]

No, he’s referring to a person who is much more gooder and more smarter, Dr. Merton L. Root III.

Well I’ll call your varus and raise you 3 degrees.