Billing > Billing
Saw Multiple Doctors for Broke Arm. Was I inappropriately coded?
MedicalCodingHelp:
The medical billing & coding process is very confusing. I hope you could help me.
I broke my arm and went to the ER. The ER reduced the fracture. I paid for the services (cash) and was referred to an orthopedic. No issues there.
I go to the first orthopedic who bills me the following:
25600 - Closed treatment of a distil radial fracture
99203 - Office visit, new patient
Two x-ray codes which are not an issue.
The services this doctor performed was taking off my splint that the ER put on, applied a new one, and said see me in two weeks. The doctor was very impersonal, saw me for a second, and I was not happy. I decided to get a second opinion.
I go to the second doctor which was much better. He reapplied my splint and took some x-rays. He gave me information stating that fractures are generally billed as a package under a single code however since he did not do the reduction he billed a-la-carte. His billing was accurate and I'm not disputing it:
99203 - office visit
2 xray codes
Code for reapplying a splint.
Is the 26500 the "package code" for complete fracture treatment which includes all visits? If so is it wrong for the first doctor to charge me under it since he is no longer treating my fracture? It seems as if I was charged for a "course of treatment" which I am not receiving since I only took the first visit and never came back. Should the second doctor be billing under the package code as oposed to a-la-carte since he is treating my fracture? The a-la-carte codes with all subsequent visits adds up to be far more than the negotiated rate for 26500.
RichardP:
MedicalCodingHelp - the comments at the following link seem to address your questions.
http://www.aapc.com/memberarea/forums/archive/index.php?t-3664.html
When billing a fracture package the application of the cast is included in the fracture care code (25600). So you would code the fracture care code and the cast supplies. You can find this info under "Application of Casts and Strapping" in the CPT book. ... We usually figure out whether to bill the fracture pkg or itemize depending on how many times dr anticipates seeing the patient.
Seems that the first and second doctors could have either charged you per visit (a-la-carte), each time you showed up, or charged you up front for all anticipated visits. The first doctor apparently chose to charge you the fracture package up front. Presumeably the first doctor was ready and able to provide you all the service he charged you for. It is you who chose to not return. If you ask nicely, maybe he will re-bill your visit on an itemized basis rather than on the fracture package basis
MedicalCodingHelp:
Thanks. I actually just reviewed my ER doctor's bill. He billed me for a 25605. It seems the same as 25600, except it involves manipulation (I assume reducing the fracture). Judging by the numbering I assume this is a package code as well.
25605 - Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation
The ER doctor is the one who performed the reduction. Is it right for him to bill me under a package since he could not have given me complete care throughout the course of the fracture? It is him who refered me to see the orthopedic.
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