ED Coding and Reimbursement Alert

" Fracture care is one of the most common procedures performed in the ED, yet many EDs barely break even treating these and other types of orthopedic injuries. To avoid denials and unnecessary fee reduction, coders must know whether the physician provided restorative or definitive care, or whether the patient was only stabilized and referred out. Identify Fracture Type The ED physician typically identifies the injury's type and location. You can locate diagnosis codes for traumatic fractures in ICD-9's injury and poisoning section, where they are classified according to body area. The ICD-9 code's fourth digit signals whether the fracture was open or closed. Compound fractures or fractures that involve foreign bodies are usually open fractures, while greenstick or simple fractures are closed.

Occasionally, the chart fails to define a fracture as either open or closed, in which case you should code it as closed. That's because an emergency physician usually provides closed treatment only, meaning the doctor doesn't surgically open the injury site, even when caring for an open fracture. When the chart lacks sufficient detail about multiple fractures, combination categories such as 817.x (Multiple fractures of hand bones) can be handy. However, if the chart includes detailed information about each fracture, then you should code each fracture separately using the fifth-digit subclassification, such as 816.02 (Fracture of one or more phalanges of hand; distal phalanx or phalanges).

In cases of multiple fractures, always list the most severe instance as the primary diagnosis. For fracture dislocations at the same anatomic site, report only the fracture code, because fractures are usually also dislocated as the result of the injury. Therefore, the ICD-9 manual lists dislocation as a nonessential modifier or one that is included in the fracture code. Treatment Details Signal Billing Choices Once you have identified the diagnosis to support medical necessity, the next crucial step to determining reimbursement is to pinpoint the type of treatment rendered. Coders must also establish what kind of care the physician provided was it restorative or definitive care? Or, was the patient simply stabilized in the ED and referred out to an orthopedic surgeon? The most confusing aspect of fracture billing is who can bill for what" " says Carol Dodd RHIT senior coding consultant for MedQuist Coding and Information Services in Gibbsboro N.J. The problem results from the fact that "fracture care is coded as a complete or bundled procedure that includes both pre- and post-op care." Note: The fracture and dislocation management codes are in the CPT manual's musculoskeletal section and include fracture and/or dislocation codes grouped under body area. This section ends with listed procedures for application of casts and strapping.Because few ED physicians provide definitive fracture care except for [...]