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fracture care

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rking12:

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:
The office visit would determine what was wrong (CPT code).  Wouldn't the fracture code be a diagnosis (ICD-9)?

Michele:
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.

rking12:
 
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:
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.

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