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Question: An orthopedic surgeon performed an open fracture treatment of the femoral shaft without placing locking screws. The surgeon performed the initial surgery without the screws intentionally as they didn’t think the screws would be necessary for the patient. A few days later, the physician noted instability in the fracture, and they performed another surgery to place the locking screws.

Is the second procedure bundled into the first surgery, since placing the locking screws is considered an optional portion of the original procedure?

Washington Subscriber

Answer: The second procedure is not bundled into the original procedure. You’ll assign 27506 (Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws) for the original surgery and then you’ll assign 27506 appended with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) for the second surgery.

Complications treated intraoperatively during a single session are bundled, but that’s not the case in your situation. The scenario you’ve presented is considered an unplanned return to the operating room (OR) during the global period.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC