Author Topic: fracture care  (Read 3038 times)

rking12

  • Newbie
  • *
  • Posts: 3
fracture care
« on: March 28, 2011, 04:43:32 PM »

There is a controversy in our office about whether or not an office visit can be billed with the initial fracture code.  It is my contention that one must bill an office visit initially because one does not know that the patient has a fracture until the patient has been examined.  After this examination, if it is determined the patient has a fracture then the fracture code would be billed as the patient is splinted or otherwise treated for their fracture. office visit-25, fracture code-59.  Is this correct? 

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: fracture care
« Reply #1 on: March 28, 2011, 05:46:34 PM »
The office visit would determine what was wrong (CPT code).  Wouldn't the fracture code be a diagnosis (ICD-9)?

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4708
    • Solutions Medical Billing
Re: fracture care
« Reply #2 on: March 29, 2011, 07:41:33 AM »
I think they mean the cpt code for the treatment of the fracture, whether they apply a cast, or a splint.  What kind of office is it?  Usually a fracture is diagnosed by one dr, then patient is referred to ortho dr for treatment.  In that case, the fracture was already diagnosed, by exam and/or xray.  Then the ortho dr usually does their own xrays and treats the fracture, they bill for the xray (both tc & pc) and the treatment, not usually an E&M.

« Last Edit: March 29, 2011, 07:44:39 AM by Michele »
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

rking12

  • Newbie
  • *
  • Posts: 3
Re: fracture care
« Reply #3 on: March 29, 2011, 10:35:13 AM »
 
It is a walk-in clinic where the same doctor that examines the patient initially is treating a simple fracture after he has made the determination that there is a fracture.  It seems that the initial examination would be the E and M code plus the treatment of the fracture code would be a separate code.

pattil88

  • Newbie
  • *
  • Posts: 43
Re: fracture care
« Reply #4 on: March 29, 2011, 10:56:44 AM »
Here's a link that should help:

http://www.hcpro.com/HIM-248390-8160/Review-codes-to-relieve-aches-and-pains-of-reporting-fractures-and-fracture-care.html

In the situation you described, it looks like the E&M can be billed w/the fx care.  Also check w/the payer(s) involved to see which modifier they want w/the E&M service - some will say to use -25, some might say -57.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4708
    • Solutions Medical Billing
Re: fracture care
« Reply #5 on: March 30, 2011, 06:48:51 AM »
I agree, the situation you describe does look like an E&M would be appropriate in addition to the treatment of the fracture.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

arms

  • Newbie
  • *
  • Posts: 10
Re: fracture care
« Reply #6 on: April 29, 2011, 06:24:47 PM »
If a patient is seen for the first time and the decision for surgery is made the day of the procedure or the day before the procedure is performed, then the surgeon can report both the procedure (fracture) code and E/M code using a 57 (if it is the decision for surgery) or 25 (significant, separate service)modifier on the E/M code. 

Here is an article from the American Academy of Orthopaedic Surgeons that is very useful when providing fracture treatment. 

http://www6.aaos.org/news/PDFopen/PDFopen.cfm?page_url=http://www.aaos.org/news/aaosnow/jul08/managing2.asp

The fracture code would not require a modifier and don't forget to bill for casting supplies ie;fiberglass/plaster and xray which are not included in the global fracture care.