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Excision Multiple Exostosis Same Finger

My surgeon performed the following procedure, excision exostosis right thumb distal phalanx and proximal phalanx. I was wondering if 26210 can be billed twice?

There was one incision which was extended. The OP report states: "We started the procedure with transverse incision following the crease on the right thumb. We could then locate mass with a ganglion cyst as well as exostosis on the distal phalanx. C-arm evaluation was used during the whole time to check for appropriate removal of the exostosis. We could then see that proximal phalanx also had a bone prominence. The wound was then extended proximally and distally in a T-shaped fashion. Care was taken to identify and protect the sensory branch of the radial nerve that was running on the radial side of the wound. With the help of a rongeur, the bone prominence exostoma was removed from the proximal phalanx distal portion was well."

thank you.

Medical Billing and Coding Forum

Is excision of exostosis included with hardware removal?

Hi,

I would like your advice on how you all would bill the below scenario. My provider wants to bill both 20680 and 27635. There are no NCCI edits with these 2 codes. But my gut is telling me that these are bundled.

An incision made over the medial malleolus.  Dissection was carried on through the skin and soft tissue.  Large exostosis was identified on the medial malleolus.  This was covering the screws.  This was removed and contoured to a smooth contour.  This was removed with an osteotome mallet and a rongeur.  This completed the partial excision of the right tibia

I then used a broken screw removal set to remove the screws in the medial malleolus.  The screws were stripped.  This was a difficult removal.  I was able to remove both screws with the reverse cutting cone.  This completed the hardware removal right tibia.

Thank you!

Medical Billing and Coding Forum

Excision of Maxillary Exostosis

I am stumped!

Oral surgeon spent 2 hours removing 4 buccal exostosis via 4 separate incisions at 4 separate locations.

After much research I came up with 41823 Excision of osseous tuberosities, dentoalveolar structures…it is a direct crosswalk of D7471 removal of lateral exostosis maxilla and mandible. My lead coder thinks it should be 21032 removal of maxillary torus…I strongly disagree…
…and, our NCCI edits program will only allow one unit of the code…it says only 1 unit can be billed – no modifier override

I believe tori are on the inside of the dental structures and buccal exostosis are on the outside of the dental structures even though they are both bony growths.

Any thoughts? Thanks in advance…

operative note excerpt:

*right maxilla
* FTMP was elevated
* distobuccal release at tooth #2
* remove the buccal exostosis
* Site was closed

* right mandible
*FTMP was elevated
*a distobuccal release at tooth #31
* remove the buccal exostosis
* Site was closed

* left maxilla
* FTMP was elevated
* distobuccal release at tooth #15
* remove the buccal exostosis
* Site was closed

*left mandible
* distobuccal release at tooth #21
* remove the buccal exostosis
* Site was closed

https://www.aetnadental.com/professi…-in-nature.pdf

Medical Billing and Coding Forum