Repeat trip to OR billing question

[billBOB213]

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What would y’all do with this, I took a patient for MIS bunionectomy and akin this past Monday. Patient said that she fell on her foot yesterday, now the great toe appears in Valgus and she doesn’t like it at all. X-rays dont show back out of screw or anything too terrible. It is, to be fair, more in Valgus than I can remember. I don’t remember it being like that or I wouldn’t have left the OR, but looks like it was my handy work. Long story short we’re gonna take her back and I want to remove the hardware, hopefully derotate the toe and reinsert screw. If I can’t get it how I want I also consented her for open akin and I’ll staple it down.
What would the correct CPT code be on this? Any ideas?

 

[PMG03470]

Well I tried but doing the emoji thing it is the revision code

Two eight one one six

Akin code

Two eight three one zero

Don’t forget modifier seven nine

 

[HardRoadPaved]

I'm confused..... it appears in valgus but no change on XR. Was it just undercorrected from the start?

Are you dealing with 1st ray hypermobility that you didnt appreciate until she bore weight?

 

[billBOB213]

Varus not Valgus, that’s my fault as I was doing too many things at once

 

[billBOB213]

IMO patient is being more ticky tacky, which is why sometimes I don’t live the elective bunion procedures. But it was rotated preop and post op looks better IMO
Edema IMO could be contributing to it too a little. Thanks for your help

 

[HardRoadPaved]

So you're gonna take back a radiographic straight toe? It's kinda either its in varus or not. Because if you have it arrow straight and then put her in valgus and she develops a complication, its pretty easy to say.... "doc why didnt you wait for that edema to calm down and reassess?" You can do a phalangeal osteotomy then (dont say akin in your notes since thats a valgus correction procedure).

 

[heybrother]

Do you have a true, representative, weight-bearing, post-op x-ray?

 

[air bud]

You are in for a rough couple of months...get some sleep

 

[air bud]

What would y’all do with this, I took a patient for MIS bunionectomy and akin this past Monday. Patient said that she fell on her foot yesterday, now the great toe appears in Valgus and she doesn’t like it at all. X-rays dont show back out of screw or anything too terrible. It is, to be fair, more in Valgus than I can remember. I don’t remember it being like that or I wouldn’t have left the OR, but looks like it was my handy work. Long story short we’re gonna take her back and I want to remove the hardware, hopefully derotate the toe and reinsert screw. If I can’t get it how I want I also consented her for open akin and I’ll staple it down.
What would the correct CPT code be on this? Any ideas?

So if it moved, obviously there had to have been some bone collapse unless you think these screws just magically backed out in a straight line motion.... In that case you reinserting screws you don't have stability and the distal fragment to hold it so what's the point. If you want to go in right now I think it's a completely different type of fixation. With MIS this is why they talk about you don't insert the screw into the capital fragment until you are 100% sure because you have one shot at it.... It would be different if you were doing this open and you could be like oh I'm going to move a half a centimeter or 1 cm different angle etc and put a screw into stable bone.

TLDR Don't try and fix this MIS.

The patient fell on her foot that's not your problem. Surely you have post-op X-rays demonstrating everything and appropriate alignment. Document accordingly none of this is your fault.

 

[billBOB213]

Thanks for replies, was looking more for coding help.
Patient is gonna wait and see if she likes it and see once some edema dies down.
I’m not gonna touch it for now.

 

[PMG03470]

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Thanks for replies, was looking more for coding help.
Patient is gonna wait and see if she likes it and see once some edema dies down.
I’m not gonna touch it for now.

I gave you coding advise in the first comment!

 

[billBOB213]

Yep absolutely

And thanks for that

Was more saying that really all I needed was coding, didn’t really wanna launch into all the other stuff with the comments above by others
Thanks again

 

[Feli]

I mostly just do the same codes for a re-do that I (or usually someone else) did for the primary procedure.
(add bone graft 20900, other procedures, hwr, etc as appropriate... seems hwr gets rejected by more and more payers now)

I do TN fusion code for revision TN non-union, MPJ fusion CPT for MPJ malunion bad position.
It's met osteotomy bunion code for revise of undercorrection for a prior Austin or whatever.
It's Lapidus codes for nonunion or undercorrection of same.
It's Weil code for revision of a Weil that didn't shorten enough.
It's TMA code for a TMA that left some osteo.
It's tendon repair code again for a re-rupture.
It's hammertoe code for revision of such.
It's skin lesion or ganglion or lipoma or whatever code for recur of those.

The comedy part is that the original surgeon who did the non-union or hallux varus or whatever likely made same/more than the surgeon doing the complex salvage... when that salvage usually takes significantly more skill and time and planning.

Not sure if anyone here uses mod -22, but I don't. It would be appropriate in many of these cases, but for PP, it pays very little extra and is basically a certainty that the case will get delayed pay and notes requested for scrutiny. I would probably use it if I worked in a hospital setup where I was mostly just salary and did complex cases without much care of them getting paid.

 

[AttackNME]

I mean you’re just doing a revision Akin sounds like. So do the Akin cpt code again with 78 modifier. Don’t do 79 modifier like the rookie suggested above.

 

[PMG03470]

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I mean you’re just doing a revision Akin sounds like. So do the Akin cpt code again with [emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]]]]] modifier. Don’t do [emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]]]]] modifier like the rookie suggested above.

Well from the original post they make no mention of this Akin being a revision. Sounds like they didn’t do one to begin with. So with that said why would it be “an unplanned return to OR” sounds to me more like an additional procedure in the global period… being seven nine

 

[billBOB213]

Did transverse capital fragment cut, fixed the bunion and also did the akin

The bunion looks great, the MPJ motion is fantastic and no pain
The issue is the akin. Toe looks more in varus
Post op X-rays showed nothing changed, but CLINICALLY looks like the great toe sits more varus now

Convinced pt to let the edema go down a little and to wait and see. I did not notice the varus on the table and with a lid pressing against the foot.
Pt admits to falling, buuut who knows how much they coulda done.

Thanks for all the billing help. No need for your bunion or surgery help.