{"id":183545,"date":"2026-08-18T09:01:55","date_gmt":"2026-08-18T09:01:55","guid":{"rendered":"https:\/\/pabau.com\/?p=183545"},"modified":"2026-08-18T10:40:44","modified_gmt":"2026-08-18T10:40:44","slug":"cpt-code-20690","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-20690\/","title":{"rendered":"CPT code 20690: Uniplane external fixation billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 20690: Uniplane external fixation billing guide\",\"description\":\"CPT code 20690 covers uniplane, unilateral external fixation. Read more on the plane rule, LT and RT modifiers, ICD-10 pairings, RVUs and Medicare rates.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-20690\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-07\",\"dateModified\":\"2026-08-18\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 20690 covers a uniplane, unilateral external fixation system, meaning pins or wires sit in one plane on one side.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Use 20690 only for uniplane constructs, because a multiplane frame is reported with CPT 20692 instead.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Most 20690 denials trace back to a missing LT or RT modifier, or a diagnosis that doesn\u2019t match the fixated bone.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Medicare pays 20690 differently in facility and non-facility settings, so confirm current rates in the CMS fee schedule lookup.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Pabau tracks every submitted claim through to payment, so a stalled 20690 claim surfaces before the filing deadline does.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 20690 covers the application of a uniplane, unilateral external fixation system, pins or wires anchored in a single plane, fixed to one side of the bone.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A nearly identical code sits right next to it for a different frame, and the split between them comes down to plane count alone, not the fracture, the frame brand, or how hard the case was. Get that wrong, or leave off a side modifier, and the claim rarely survives its first read at the payer. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Here\u2019s what has to be in the operative note before 20690 goes anywhere near a claim.<\/p>\n\n\n\n<h2 id=\"h-what-cpt-code-20690-covers\" class=\"wp-block-heading\">What CPT code 20690 covers<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 20690 covers the application of a uniplane, unilateral external fixation system. In plain terms, pins or wires enter the bone in a single plane, on one side, and the frame stays outside the skin.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That definition is narrow, which is exactly why the code gets misused. Billers reach for it the moment they see \u00ab\u00a0external fixation\u00a0\u00bb in the operative note, without checking how many planes the surgeon used. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association&rsquo;s CPT code set<\/a> spells it out as \u00ab\u00a0Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system.\u00a0\u00bb The code sits in the Musculoskeletal System chapter, in the introduction or removal subsection running from 20690 to 20697.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Three words in that descriptor carry the billing weight:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Uniplane:<\/strong> the pins or wires sit in a single plane.<\/li>\n\n\n\n<li><strong>Unilateral:<\/strong> the frame is applied to one side of the bone segment.<\/li>\n\n\n\n<li><strong>External:<\/strong> the hardware stays outside the skin, with nothing crossing the fracture internally.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">All three have to match the operative note before the code applies. Miss one and you\u2019re coding a different procedure.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-when-surgeons-use-a-uniplane-external-fixator\" class=\"wp-block-heading\">When surgeons use a uniplane external fixator<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Surgeons choose a uniplane frame when a fracture needs stable support quickly, without hardware crossing the fracture line. Sometimes the frame is temporary, holding the limb until swelling settles. In other cases it is the definitive treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Cases that commonly trigger CPT 20690 include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Closed or open fractures of the radius, ulna, tibia, fibula, metacarpal, or phalanges needing temporary support<\/li>\n\n\n\n<li>Staged treatment, where the frame holds the limb until definitive fixation or arthroplasty<\/li>\n\n\n\n<li>Infected fractures or osteomyelitis, where internal hardware carries too much risk<\/li>\n\n\n\n<li>Pediatric fractures treated with percutaneous pinning and external wires<\/li>\n\n\n\n<li>Periarticular fractures with badly compromised soft tissue<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Orthopedic surgery, hand surgery, trauma surgery, and <a href=\"https:\/\/pabau.com\/industry\/sports-medicine-software\/\">sports medicine practices<\/a> bill this code most often. Plastic surgeons see it too, when skeletal stabilization forms part of a composite digital repair.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Every frame comes off eventually, and the patient then moves into rehab. Hand and wrist cases usually land with <a href=\"https:\/\/pabau.com\/industry\/occupational-therapy-software\/\">occupational therapy<\/a> teams, so plan that referral while you book the removal.<\/p>\n\n\n\n<h2 id=\"h-what-the-operative-note-must-say-before-you-bill\" class=\"wp-block-heading\">What the operative note must say before you bill<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Four elements decide whether the note supports 20690: plane, side, hardware type, and the specific bone. If a coder can\u2019t point to all four in the text, the claim is a guess.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-20690\/digital-forms.webp\" alt=\"Pabau digital forms template library\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&rsquo;s digital forms come with a template library you can customize, so the fields your coders need are captured at the point of care.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Plane.<\/strong> The note has to state that the pins or wires sit in one plane. Wording like \u00ab\u00a0two-plane construct\u00a0\u00bb or \u00ab\u00a0multiplanar\u00a0\u00bb rules 20690 out.<\/li>\n\n\n\n<li><strong>Side.<\/strong> The note names the side treated. Bilateral application means two units of service, with LT and RT.<\/li>\n\n\n\n<li><strong>Hardware.<\/strong> Confirm the frame is external, with pins through the skin, rather than an intramedullary nail or a plate.<\/li>\n\n\n\n<li><strong>Bone and fracture type.<\/strong> This drives the diagnosis code, and payers check the pairing.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">On bundling, 20690 usually stands apart from the fracture treatment codes, such as 25600 to 25609 for a distal radius. Report it separately when the frame is the primary method of stabilization rather than a step inside fracture care. Check the current <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/national-correct-coding-initiative-ncci-edits\" target=\"_blank\" rel=\"nofollow noopener\">NCCI pair edits<\/a> before you submit, because they change quarterly.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A standardized <a href=\"https:\/\/pabau.com\/templates\/operation-notes\/\">operation note template<\/a> is the cheapest fix available here. Once plane, side, and hardware sit in fixed fields, they stop going missing.<\/p>\n\n\n\n<h2 id=\"h-20690-vs-20692-comes-down-to-plane-count\" class=\"wp-block-heading\">20690 vs 20692 comes down to plane count<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Plane count decides this one. The brand of frame, the number of pins, and the difficulty of the case make no difference.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Feature<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 20690<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 20692<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Uniplane (pins or wires in 1 plane), unilateral<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiplane (pins or wires in more than 1 plane), unilateral<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Pin or wire configuration<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Single plane orientation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Two or more plane orientations<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Common use case<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Simple fracture stabilization, temporary bridging<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Comminuted fractures, complex periarticular injury<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Documentation trigger word<\/td>\n<td style=\"padding:12px 16px;color:#374151\">\u00ab\u00a0Uniplanar,\u00a0\u00bb \u00ab\u00a0single-plane,\u00a0\u00bb \u00ab\u00a0one plane\u00a0\u00bb<\/td>\n<td style=\"padding:12px 16px;color:#374151\">\u00ab\u00a0Multiplanar,\u00a0\u00bb \u00ab\u00a0two-plane,\u00a0\u00bb \u00ab\u00a0delta frame\u00a0\u00bb<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU, relative<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower of the two<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher, reflecting added complexity<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Here is how that plays out in a chart. A patient arrives with an open tibial shaft fracture, and the surgeon places four pins, all anterior, joined by one bar. Four pins, one plane, so the code is 20690. Add a second bar running medially with pins in a new plane, and the same case becomes 20692.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When the note reads ambiguously, query the surgeon before coding. Upcoding to 20692 on a vague note invites an audit, while downcoding a genuine multiplane frame leaves money on the table.<\/p>\n\n\n\n<h2 id=\"h-where-20690-sits-in-the-fixation-code-family\" class=\"wp-block-heading\">Where 20690 sits in the fixation code family<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The 20690 series covers the whole life of a frame, from application through adjustment to removal. Adjustment and revision work has its own code, <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-20693\/\">CPT code 20693<\/a>, and it\u2019s easy to leave unbilled.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Descriptor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key distinction<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">20690<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Uniplane, unilateral external fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Single plane, one-side application<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">20692<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiplane, unilateral external fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple planes, higher complexity<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">20693<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Adjustment or revision of external fixation system requiring anesthesia (eg, new pins, wires, rings, or bars)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Post-application changes made under anesthesia<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">20694<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Removal, under anesthesia, of external fixation system<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Removal that requires anesthesia<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">20696<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiplane external fixation with stereotactic computer-assisted adjustment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Spatial frame work, imaging and alignment computations included<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">20697<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each additional adjustment and computation for a spatial frame<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Add-on code, reported only alongside 20696<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Watch one code that looks like family. CPT 20670 covers superficial implant removal, and it sits in a separate subsection of the musculoskeletal chapter. Treat it as related work, not as part of the 20690 series, and never as a stand-in for 20694.<\/p>\n\n\n\n<h2 id=\"h-laterality-modifiers-decide-whether-20690-gets-paid\" class=\"wp-block-heading\">Laterality modifiers decide whether 20690 gets paid<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Laterality comes first. Most payers require LT or RT on an extremity procedure, so a unilateral claim without one is a denial waiting to happen.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fixation applied to the left extremity<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fixation applied to the right extremity<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">51<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple procedures<\/td>\n<td style=\"padding:12px 16px;color:#374151\">20690 performed alongside a separate primary procedure, usually appended to the secondary service<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fixation is a separate, distinct service, not bundled with another procedure that day<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">58<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Staged or related procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fixation is planned as a staged step after a prior service in the global period<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The other three modifiers depend on what else happened in the same session. Policy on 51 and 59 varies between plans, so read the contract instead of assuming. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When a claim does come back, the <a href=\"https:\/\/pabau.com\/procedure-codes\/denial-codes-in-medical-billing\/\">denial codes<\/a> on the remittance name the rule you broke.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Flag every 20690 claim for a laterality check before it goes out. Missing LT or RT is the most common denial reason in this code family. Build the check into your charge capture template so nobody can skip it at entry.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-the-diagnosis-code-has-to-match-the-fracture\" class=\"wp-block-heading\">The diagnosis code has to match the fracture<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnosis has to name the bone the surgeon fixated. Payers cross-check that pairing, so a spine code on an extremity fixation claim denies on sight.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Common scenario<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S52.501A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified fracture of the lower end of right radius, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distal radius fracture, temporary bridging<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S82.201A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified fracture of shaft of right tibia, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open or closed tibial shaft fracture<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S82.401A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified fracture of shaft of right fibula, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fibula fracture needing external support<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S62.301A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified fracture of second metacarpal bone, left hand, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Metacarpal fracture, hand surgery<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S62.501A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of unspecified phalanx of right thumb, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Thumb fracture, digital pinning<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S72.001A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of unspecified part of neck of right femur, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Femoral fracture, temporary frame before definitive care<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S52.001A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified fracture of upper end of right ulna, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Proximal ulna fracture<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The 7th character is the other half of the job. A marks the initial encounter, D the subsequent one, and S a sequela. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Follow-up care on an open tibial shaft fracture moves to a code like <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s82251e\/\">S82.251E<\/a> rather than the initial-encounter version. The <a href=\"https:\/\/www.aapc.com\/codify\/icd-10-crosswalk.aspx\" target=\"_blank\" rel=\"nofollow noopener\">AAPC crosswalk<\/a> is a quick way to sanity-check a pairing before submission.<\/p>\n\n\n\n<h2 id=\"h-how-a-20690-claim-moves-to-payment\" class=\"wp-block-heading\">How a 20690 claim moves to payment<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A 20690 claim travels five steps, and it can stall at any of them.<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Charge capture.<\/strong> The code and the laterality modifier go on here, or they never go on at all.<\/li>\n\n\n\n<li><strong>Scrubbing.<\/strong> The claim gets checked for missing fields, invalid code pairs, and demographic mismatches.<\/li>\n\n\n\n<li><strong>Submission.<\/strong> The claim leaves as an <a href=\"https:\/\/pabau.com\/blog\/837-file\/\">837 file<\/a>, usually through a <a href=\"https:\/\/pabau.com\/blog\/medical-claims-clearinghouse\/\">clearinghouse<\/a> rather than a payer portal.<\/li>\n\n\n\n<li><strong>Adjudication.<\/strong> The payer prices the line, applies bundling edits, and tests medical necessity against the diagnosis.<\/li>\n\n\n\n<li><strong>Remittance.<\/strong> Payment or denial returns as an <a href=\"https:\/\/pabau.com\/blog\/electronic-remittance-advice\/\">electronic remittance advice<\/a>, with reason codes attached.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Two of those five steps cause most of the trouble. Charge capture is where laterality goes missing, and adjudication is where a mismatched diagnosis gets caught. The rest is plumbing.<\/p>\n\n\n\n<h2 id=\"h-medicare-pays-20690-differently-by-setting\" class=\"wp-block-heading\">Medicare pays 20690 differently by setting<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Where the procedure happens changes the payment. The <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule lookup<\/a> gives locality-specific rates, and that is the figure to quote internally.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Rate basis<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Non-facility (office)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher payment, because the practice carries the expense<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Uses non-facility practice expense RVUs, and is uncommon for this procedure<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Facility (hospital or ASC)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower physician payment, with the facility billing separately<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The usual setting for fixation under general or regional anesthesia<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Geographic variation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Geographic practice cost index (GPCI) adjustments apply<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Rates move by MAC locality, so confirm through the CMS lookup<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Rates and the conversion factor change every year, and they vary by MAC jurisdiction. Pull the current figure from CMS before you build it into a contract model. A third-party rate table is a starting point, never the answer.<\/p>\n\n\n\n<h2 id=\"h-how-rvus-turn-into-a-payment-amount\" class=\"wp-block-heading\">How RVUs turn into a payment amount<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare prices 20690 through the resource-based relative value scale, known as RBRVS. Three RVU components are added together, then multiplied by the conversion factor and adjusted for local costs.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What it measures<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Setting impact<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physician time, skill, and intensity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same in every setting<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice expense RVU (facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Overhead when the work happens in a facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower, since the facility absorbs most overhead<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice expense RVU (non-facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Overhead when the work happens in an office<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher, since the practice carries the overhead<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Professional liability expense<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same or close to it across settings<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU x conversion factor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The payment calculation itself<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Confirm the conversion factor each year in the CMS final rule<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The conversion factor is the moving part. It resets annually, and congressional action can shift it again mid-year, so check it before projecting revenue for a fixation program.<\/p>\n\n\n\n<h2 id=\"h-commercial-rates-and-when-prior-authorization-applies\" class=\"wp-block-heading\">Commercial rates and when prior authorization applies<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Commercial payers usually benchmark 20690 against the Medicare rate. Contracted amounts commonly land between 110% and 160% of the fee schedule, depending on the market and the agreement. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Treat that as a general industry range, because your own contract is the only figure that counts.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Prior authorization depends on the setting. Emergency fracture management rarely needs it, while an elective or staged application often does. Before an elective case, work through the <a href=\"https:\/\/pabau.com\/blog\/prior-authorization-process\/\">prior authorization process<\/a> in this order:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Check the payer&rsquo;s provider portal for its current policy on 20690<\/li>\n\n\n\n<li>Confirm whether the facility or the surgeon&rsquo;s office owns the request<\/li>\n\n\n\n<li>Document medical necessity with the specific fracture code and the indication<\/li>\n\n\n\n<li>Record the authorization number where the biller will see it at charge entry<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Traditional Medicare doesn\u2019t require prior authorization for 20690 under the Physician Fee Schedule. Medicare Advantage plans set their own rules, so check the plan rather than the program.<\/p>\n\n\n\n<h2 id=\"h-run-this-check-before-you-submit\" class=\"wp-block-heading\">Run this check before you submit<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Five quick checks catch nearly everything that denies on this code.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The note says one plane. If it says two, the code is 20692.<\/li>\n\n\n\n<li>The note names the side, and the claim carries a matching LT or RT.<\/li>\n\n\n\n<li>The hardware is external, with pins or wires passing through the skin.<\/li>\n\n\n\n<li>The diagnosis names the bone that was fixated, at the right level.<\/li>\n\n\n\n<li>The 7th character matches this encounter, not the previous one.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Then look at the calendar. Every payer sets its own <a href=\"https:\/\/pabau.com\/blog\/timely-filing-limits\/\">timely filing limit<\/a>, and even a <a href=\"https:\/\/pabau.com\/blog\/clean-claim\/\">clean claim<\/a> pays nothing once that window closes.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a quarterly denial audit filtered to 20690 and sort it by reason code. If modifier denials like CO-4 or CO-16 keep repeating, charge capture is the first place to look. Fix the template and the individual claims stop coming back.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-pabau-keeps-20690-claims-moving\" class=\"wp-block-heading\">How Pabau keeps 20690 claims moving<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Coding a fixator case will always be hands-on work. What a practice can change is what happens to the claim afterwards. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">Practice management software<\/a> like Pabau keeps the treatment note, the invoice, and the insurance claim on one client record. Nobody has to rebuild a case from three systems to answer one payer question.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Each insurer a patient holds is linked to their record, so the claim goes out against the right policy. Pabau&rsquo;s <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> then submits electronically and tracks where the claim sits, from submitted through processing to paid or error.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That status view is the useful part for a billing team. A 20690 claim that errors out shows up while there is still time to correct and refile it. When the same claim keeps landing in the error column, the fix belongs in charge capture rather than in another round of resubmissions.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Track every 20690 claim through to payment                <\/h3>\n\n                <p class=\"description\">\n                    Pabau keeps the treatment note, the invoice, and the insurance claim on one client record, then tracks each submitted claim to payment. You see a stalled claim while there is still time to fix it.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau practice management platform\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 20690 rewards precision over speed. Read the operative note for plane, side, and hardware type before anyone opens the charge screen. When one of the three reads unclearly, a single query to the surgeon costs far less than a rework and an appeal.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Most of the damage on this code comes from mundane errors. An upcode on a vague note, a missing LT modifier, or a stale 7th character will each stop a claim. Build the five-point check into charge capture and those errors mostly disappear.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Want to see what happens to the claim once the coding is done? <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> and we\u2019ll show you how Pabau tracks orthopedic claims from submission through to payment.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing another musculoskeletal procedure this week?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-20550\/\">CPT code 20550<\/a> covers tendon and ligament injections, with the same documentation discipline applied to a much smaller procedure.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding a bone biopsy alongside trauma work?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-20250\/\">CPT code 20250<\/a> walks through the open biopsy rules and the documentation payers expect.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need a fracture diagnosis code with the right 7th character?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s42463g\/\">S42.463G<\/a> shows how encounter type and healing status change the code you submit.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Denials piling up across more than one code?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/denial-management-in-healthcare\/\">Denial management in healthcare<\/a> sets out how to work a denial queue by root cause instead of claim by claim.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Wondering where claims sit in the wider revenue cycle?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/what-is-revenue-cycle-management\/\">Revenue cycle management<\/a> maps the full path from booking to posted payment.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1787042646467\"><h3 class=\"schema-faq-question\">Does CPT 20690 have a global period?<\/h3> <p class=\"schema-faq-answer\">Yes. Under the Medicare Physician Fee Schedule, 20690 carries a 90-day global period. Routine post-operative visits and dressing changes sit inside it. Confirm the global days indicator in the fee schedule lookup before you bill follow-up care.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042646468\"><h3 class=\"schema-faq-question\">Can you bill 20690 and 20692 for the same fracture?<\/h3> <p class=\"schema-faq-answer\">No. One construct gets one code, chosen by plane count. Say the surgeon later converts a uniplane frame into a multiplane frame. That work is usually reported as a revision with 20693, not as a second application.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042646469\"><h3 class=\"schema-faq-question\">Who bills for the external fixator hardware?<\/h3> <p class=\"schema-faq-answer\">In a hospital or ambulatory surgery center, the facility bills for the device. CPT 20690 pays the surgeon for the work of applying the frame, not for the frame itself.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042646470\"><h3 class=\"schema-faq-question\">Is 20694 the right code for removing a fixator in the office?<\/h3> <p class=\"schema-faq-answer\">Only when the removal requires anesthesia, which is how 20694 is defined. A straightforward office removal without anesthesia is not reported with it, and usually falls inside the global period.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042646471\"><h3 class=\"schema-faq-question\">Which place of service code goes with 20690?<\/h3> <p class=\"schema-faq-answer\">The setting where the surgery happened. Trauma cases usually carry place of service 21 for an inpatient hospital or 22 for hospital outpatient. An application in an ambulatory surgery center uses 24.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT code 20690 covers uniplane, unilateral external fixation. Read more on the plane rule, LT and RT modifiers, ICD-10 pairings, RVUs and Medicare rates.<\/p>\n","protected":false},"author":85,"featured_media":183544,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"85","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[],"class_list":["post-183545","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT code 20690: Uniplane external fixation billing guide<\/title>\n<meta name=\"description\" content=\"CPT code 20690 covers uniplane, unilateral external fixation. See the plane rule, LT\/RT modifiers, ICD-10 pairings, and RVUs.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-20690\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT code 20690: Uniplane external fixation billing guide\" \/>\n<meta property=\"og:description\" content=\"CPT code 20690 covers uniplane, unilateral external fixation. 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