99203 billed with 27786

[ddmayx]

When an office bills for 27786 along with the office visit. What exactly should he of done during my visit? I had a partial plaster splint from the urgent care that the Dr's nurse cut off. I had  brought my xrays from the Urgent care also. The dr. walked in looked at my badly bruised ankle and the xrays that were up. Told me it was a clean break and that I needed a cast for 6 weeks. I talked him into the walking boot since I'm such a big guy and have my own business I can't function on crutches. He agreed. I had a walking boot from a previous break that I had taken with me for my office visit with the Ortho. The nurse then took an ace bandage wrapped my ankle and my dad went to get the boot from the car. I put it on and that was it. I can't understand exactly what the doctor did that constitued billing the 27786. Can anyone possibly explain to me what 27786 physically is? I know the meaning of the code out of the CPT books but I need to know what that is in physical terms. The drs office said that was basically for him to look at my xrays and tell me it was broke. I would think that would be included in the office visit. Please help just this ortho bill my part after insurance is 725.00 since I have a $3000 deductible.

[Michele]

The 27786 means - closed treatment of distal fibular fracture (lateral malleolus); without manipulation.  So since he cut the cast off, read the xrays, and discussed and agreed with you upon treatment, that code does seem appropriate.  Usually unless other services are performed, it's the office visit that wouldn't be billed, it would be part of the 27786.  Since this is the first time the dr saw you, the 99203 would be appropriate.

Closed treatment of a fracture without manipulation basically means that you had an uncomplicated fracture that did not pierce the skin.  Without manipulation means that the dr did not need to do anything to 'line up' the fracture for healing.

Hope that helps.

Michele

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